Video-Assisted Thoracoscopic Sympathectomy for Palmar Hyperhidrosis: A Meta-Analysis of Randomized Controlled Trials

Abstract

ObjectivesVideo-assisted thoracoscopic sympathectomy (VTS) is effective in treating palmar hyperhidrosis (PH). However, it is no consensus over which segment should undergo VTS to maximize efficacy and minimize the complications of compensatory hyperhidrosis (CH). This study was designed to compare the efficiency and side effects of VTS of different segments in the treatment of PH.MethodsA comprehensive search of PubMed, Ovid MEDLINE, EMBASE, Web of Science, ScienceDirect, the Cochrane Library, Scopus and Google Scholar was performed to identify studies comparing VTS of different segments for treatment of PH. The data was analyzed by Revman 5.3 software and SPSS 18.0.ResultsA total of eight randomized controlled trials (RCTs) involving 1200 patients were included. Meta-analysis showed that single segment/low segments VTS could reduce the risk of moderate/severe CH compared with multiple segments/high segments. The risk of total CH had a similar trend. In the subgroup analysis of single segment VTS, no significant differences were found between T2/T3 VTS and other segments in postoperative CH and degree of CH. T4 VTS showed better efficacy in limiting CH compared with other segments.ConclusionsT4 appears to be the best segment for the surgical treatment of PH. Our findings require further validation in more high-quality, large-scale randomized controlled trials.

Compensatory hyperhidrosis after different surgeries at the same sympathetic levels: a meta-analysis

“…While others believed that the extent of resection had no effect on the occurrence of CH (23,24). Although plenty of studies have paid attention to the sympathetic levels (25)(26)(27)(28), the optimal sympathetic levels are still controversial. To determine which sympathetic surgical technique makes the lowest incidence of CH after surgery, we performed this meta-analysis.…”

Endoscopic Thoracic Sympathectomy for the Treatment of Hyperhidrosis

“…We had no cases of compensatory hyperhidrosis in our patients. In a meta-analysis of eight randomized trials including 1200 patients undergoing video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis, the risk of compensatory hyperhidrosis was lower with sympathectomy at lower segments compared to higher segments (15). Zhang and colleagues demonstrated comparable results in their meta-analysis of 10 articles consisting of 1195 patients (16).…”

Anxiety after Sympathectomy in patients with primary palmar hyperhidrosis may prolong the duration of compensatory hyperhidrosis

“…Primary palmar hyperhidrosis (PH) is a condition marked by excessive perspiration, which can be exacerbated by stress and anxiety [ 1 ]. Sympathectomy by video-assisted thoracic surgery (VATS) has been used in PH treatment with acceptable results [ 2 ]; however, post-operative compensatory hyperhidrosis (CH) is a frequent side effect (morbidity, 44–86% [ 3 ]) that significantly lowers the quality of life [ 4 ].…”