Thoracic sympathectomy for hyperhidrosis: from surgical indications to clinical results

Vannucci, Fernando; Araújo, José Augusto

doi:10.21037/jtd.2017.04.04

Cited by 53 publications

(57 citation statements)

References 43 publications

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“…Purtuloglu et al have reported 95% success rate in 46 patients [2]. In their big series on 407 patients with palmar hyperhidrosis, Vannucci et al reported 1% (4 cases) recurrence among their patients [14]. In our series, the recurrence was unilateral in both cases and both patients chose not to have any further intervention and we recommended trying medical management for a longer period of time.…”

Section: Discussionmentioning

confidence: 51%

Thoracoscopic excision versus radiofrequency ablation of the sympathetic chain as a treatment for palmar hyperhidrosis: comparative study

et al. 2020

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Background: Hyperhidrosis is an excess sweat secretion. Various modalities of treatment exist for hyperhidrosis. Although medical treatment is the first line of treatment, its long-term outcome is not satisfactory. In this study, we compared the results of thoracoscopic excision with that of radiofrequency ablation of the sympathetic chain as a treatment of palmar hyperhidrosis. Results: During the period from January 2014 to December 2017, 42 patients with palmar hyperhidrosis after failure of medical treatment presented to Departments of Pediatric Surgery and Neurosurgery, Faculty of Medicine. They were 26 males and 16 females. Their ages ranged between 11 and 42 years (mean 21.78 years). Twenty patients underwent thoracoscopic excision of the sympathetic chain (in Pediatric Surgery Department), while 22 patients underwent radiofrequency ablation of the sympathetic chain (in Neurosurgery Department). For the thoracoscopic sympathectomy group, the mean operative time was 27.39 min, the mean length of hospital stay was 24.78 h, the mean sweating scale decreased from 3.28 preoperatively to 1.33 1 year postoperatively, and the main postoperative complication was compensatory hyperhidrosis (40%). For the radiofrequency ablation group, the mean operative time was 55 min, the mean length of hospital stay was 20.64 h, the mean sweating scale decreased from 3.29 preoperatively to 1.57 1 year postoperatively, and the main postoperative complication was recurrence of hyperhidrosis (27%). Conclusion: Thoracoscopic excision is more effective than radiofrequency ablation of the sympathetic chain in improving palmar hyperhidrosis. However, it has a higher risk of developing compensatory hyperhidrosis.

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Section: Discussionmentioning

confidence: 51%

Thoracoscopic excision versus radiofrequency ablation of the sympathetic chain as a treatment for palmar hyperhidrosis: comparative study

et al. 2020

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“…Sympathicotomy is now the most common surgical procedure. 15 After the operation, we found that palm sweat secretion was the same or more than before the operation in some patients but disappeared 1 or 2 days later. CH may have a relationship with nerve trauma.…”

Section: Discussionmentioning

confidence: 77%

Changes in Palm Temperature as Predictor of Long-term Cure of Sympathicotomy for Palmar hyperhidrosis?

Liu

Kang

Huang

et al. 2018

J Neurol Surg A Cent Eur Neurosurg

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Objectives To investigate the long-term relationship between intraoperative temperature changes of the palm, treatment effects and compensatory hyperhidrosis (CH). Methods We retrospectively analyzed the data of 41 patients with palmar hyperhidrosis who underwent bilateral endoscopic sympathicotomy 3 to 6 years ago. Before and after the operation, changes in ipsilateral palm temperature were monitored and recorded to evaluate the curative effect of the sympathicotomy. Results All operations were performed successfully. Concerning cure, there was no statistically significant difference between patients with different maximum temperature (Tmax) values (p = 0.455). There was a very weak correlation between postoperative palm temperature (34.309 ± 1.377°C) (p = 0.049; correlation coefficient − 0.218). The T3 + T4 sympathicotomies had a higher Tmax (p = 0.000). The incidence and degree of CH had no relationship with Tmax in the left (p = 0.266 and p = 0.168, respectively) or the right hand (p = 0.640 and p = 0.824, respectively). Conclusions Temperature change has a relationship with surgery, but it cannot directly predict the long-term curative effect of a sympathicotomy or the occurrence of CH. Additional studies are required.

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“…Better visualization of the stellate ganglion and its preservation to avoid development of post-operative Horner's syndrome. [11] As noted in many studies, the plantar domain affects considerable part of those patients of about 45% [4]; while others reported incidence of plantar domain of 70 to 100 % of patients with primary hyperhidrosis; latter researchers used extended technique of ablation from R3 to R12 to manage those cases [12]. In the Society of Thoracic Surgeons 2011 Expert Consensus for the Surgical Treatment of Hyperhidrosis [13], no recommendations for plantar domain management were noted.…”

Section: Discussionmentioning

confidence: 99%

Palmo-Plantar Hyperhidrosis: Does Drainless One-port Thoracoscopic Sympathectomy (DOTS) help?

Aly

Soliman

Zaid

et al. 2020

Preprint

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Objectives: Primary hyperhidrosis (PH) still impacts negatively the patients' quality of life (QoL). Progressively, it leads to poorer QoL regardless of gender; finally, it ends up causing psycho-social and professional embracement to patients. The thoracoscopic sympathectomy (TS) has been used safely and effectively for control of palmar hyperhidrosis; but it is still questionable in palmo-plantar type. We assessed the benefits of drainless one-port thoracoscopic sympathectomy (DOTS) in palmo-plantar and palmar hyperhidrosis. Methods: This prospective study comprised 213 consecutive patients with PH who underwent bilateral simultaneous DOTS. We used the Hyperhidrosis Disease Severity Scale (HDSS) scoring system for assessment of quality of life pre-and post-operatively. Follow up continued for one-year interval for quality of life, recurrence, and compensatory hyperhidrosis. Results: All patients experienced immediate complete resolution of hyperhidrosis postoperatively. Recurrence encountered in one patient during first 6 months. All patients had improved quality of life postoperatively; but at the end of 1-year follow up, 2.8 % of patients were still suffering moderate to severe impaired QoL. Mean hospital stay was 31.79±17.5 hours. We found significant longer hospital stay in palmar group than palmo-plantar group. There was no significant difference between both groups in neither operative time, recurrence, nor compensatory hyperhidrosis. Conclusions: DOTS offers better quality of life for patients with primary hyperhidrosis even the palmo-plantar type. The palmo-plantar type benefits similarly to the palmar type. In palmo-plantar hyperhidrosis, we should rethink again about post-operative plantar hyperhidrosis; it is accepted redistribution compensatory hyperhidrosis rather than a miserable recurrence. Introduction: Hyperhidrosis is a sweat glands' benign functional disorder. Usually, it presents by heat or emotional stimulated excessive sweating beyond the physiological needs. Moreover, it causes psycho-social and professional embracement that negatively impacts the quality of life (QoL). [1-3] Hyperhidrosis may be primary or secondary. The etiology of primary hyperhidrosis (PH) is still unknown. It affects about 0.6 to 1% in the general population. The most usual sites or domains of hyperhidrosis are the hands in 25% of cases, armpit in 20% and both in 55%, while plantar hyperhidrosis noted in 45% of cases. [2, 4] Management of those patients includes many medications as topical medication and botulinum toxin injection. [5] In 1920s, the trans-thoracotomy surgical treatment started to appear in medical practice with significant patient morbidity so, it failed to generate widespread acceptance. [6] Evolving thoracoscopy approach enhanced the thoracoscopic sympathectomy to become the surgical technique of choice for treating PH. This minimally invasive procedure is simple and safe, with a high success rate with low morbidity and short hospital stay.[7] Although being an effective method for management of PH,...

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Thoracic sympathectomy for hyperhidrosis: from surgical indications to clinical results

Cited by 53 publications

References 43 publications

Thoracoscopic excision versus radiofrequency ablation of the sympathetic chain as a treatment for palmar hyperhidrosis: comparative study

Thoracoscopic excision versus radiofrequency ablation of the sympathetic chain as a treatment for palmar hyperhidrosis: comparative study

Changes in Palm Temperature as Predictor of Long-term Cure of Sympathicotomy for Palmar hyperhidrosis?

Palmo-Plantar Hyperhidrosis: Does Drainless One-port Thoracoscopic Sympathectomy (DOTS) help?

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