Thoracoscopic Sympathicotomy vs Sympathectomy in Primary Hyperhidrosis

Abstract

BackgroundPrimary hyperhidrosis (P.H.H.) is characterized by excessive sweating in certain parts of body. It’s estimated prevalence is 0%-6.1% in different populations. In Asian population its prevalence is around 3%. In 57% of cases, there is a positive family history.ObjectivesTo evaluate and compare the early and late satisfaction, outcomes and complications of thoracoscopic sympathectomy and sympathicotomy in the treatment of primary hyperhidrosis.Materials and MethodsFrom April 2007 to January 2011, we prospectively treated 60 primary hyperhidrosis patients via thoracoscopic surgery. The first 30 patients underwent sympathectomy and the next 30 patients underwent sympathicotomy. We evaluated early and late satisfactions, outcomes and complications on the first visit (5-8days) following surgery and 12 months after surgery, for all patients.ResultsThe mean operative time was 66.3 minutes in sympathicotomy group and 110.8 minutes in sympathectomy group (P < 0.001). There were no significant differences between the two groups in overall early and late satisfaction, gustatory sweating, pompholyx and post-operative pain. There was comparatively less early and late compensatory sweating (C.S.), and other adverse influences of C.S. in the sympathicotomy group.ConclusionsBecause of shorter operative time, less C.S. and less adverse influence of C.S., sympathicotomy seems a better treatment for primary hyperhidrosis, compared with sympathectomy.

Bilateral sympathicotomy for hyperhidrosis without using single-lung ventilation

“…The effectiveness of sympathicotomy for axillary hyperhidrosis is slightly lower than for palmar hyperhidrosis and it varies between 86% and 93% (9). In this study, the effectiveness of sympathicotomy for axillary hyperhidrosis was 93.3%.…”

Comparisons of the clinical outcomes of thoracoscopic sympathetic surgery for palmar hyperhidrosis: R4 sympathicotomy versus R4 sympathetic clipping versus R3 sympathetic clipping

“…Although it is benign in nature, it can nevertheless be a cause of significant social, emotional, and professional disability. There is a potential role for genetic predisposition for primary hyperhidrosis, given a positive family history, in up to 25% to 50% of affected individuals (2,3,5). Non-surgical treatment with iontophoresis, botulinum toxin, injections, etc.…”

“…The medical records contained the patient characteristics, operative procedures, and perioperative results. We interviewed the patients using a previously reported and revised telephone questionnaire (2) in June 2015. The telephone questionnaire addressed degree of palmar sweating, grade of CS, grade of satisfaction, and recurrence/failure.…”

“…Although it is a benign disorder, primary hyperhidrosis can interfere with daily activities of living. Treatment for primary hyperhidrosis includes topical antiperspirants, botulinum toxin A, oral medication, and iontophoresis; however, these treatments are not effective and their effects are usually transient (1)(2)(3).…”

Up-to-date Treatments of Primary Hyperhidrosis with Focus on Sympathectomy and Sympathicotomy; A Narrative Review

“…The sympathetic ganglia dermatomes overlap each other, but it appears that the T2 ganglion is mostly engaged in innervation of the head, neck, and upper extremity. The T3 ganglion is engaged in the innervation of the upper extremity and upper third of the axillary fossa, and the T4 ganglion is engaged in innervation of the upper extremity and lower third of the axillary fossa [9,10,20,21].…”