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Housset M, Dessertenne G, Marchand E, Daligault M, Maillard H. A multicentre retrospective study of lumbar sympathectomy for plantar hyperhidrosis: satisfaction and postoperative complications. Clin Exp Dermatol 2024; 49:241-246. [PMID: 37966306 DOI: 10.1093/ced/llad373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Primary plantar hyperhidrosis has a severe impact on quality of life and conservative treatments are only effective in the short term. Thoracic sympathectomy has proven its effectiveness in the treatment of palmar hyperhidrosis, but lumbar sympathectomy for plantar hyperhidrosis remains poorly described. OBJECTIVES To report the satisfaction of patients with primary plantar hyperhidrosis treated with mechanical lumbar sympathectomy as well as their postoperative complications. METHODS This was a multicentre retrospective observational study of 16 patients with primary plantar hyperhidrosis, treated with mechanical lumbar sympathectomy from December 2012 to October 2022. Patients' characteristics were collected from medical records. Quality of life, postoperative satisfaction and complications were evaluated using a standardized questionnaire. RESULTS Lumbar sympathectomy was performed on 16 patients, 14 were women and 2 were men with a total of 31 procedures. Fourteen (88%) patients were satisfied and would recommend the surgery to other patients. Compensatory hyperhidrosis occurred in 75% of patients, recurrence of hyperhidrosis in 31% and sexual dysfunction in 19%. CONCLUSIONS Lumbar sympathectomy provides satisfying results for plantar hyperhidrosis with acceptable postoperative complications, regardless of sex. Compensatory hyperhidrosis was the most frequent complication but had no impact on patient satisfaction. In the literature, data on the risk of sexual dysfunction are reassuring and in our study only one of two men experienced transient ejaculation disorder.
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Affiliation(s)
| | | | - Etienne Marchand
- Vascular and Thoracic Surgery Department, CHU Tours, Tours, France
| | - Mickaël Daligault
- Vascular and Thoracic Surgery Department, CHU Angers, Angers, France
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Marinho-Junior CH, Czeczko NG, Cechin VL, Zeni JOV, Ribas-Filho JM. IS THERE NEURAL AND FUNCTIONAL RECOVERY AFTER CLIP REMOVAL IN CERVICAL EXPERIMENTAL SYMPATHECTOMY? ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2021; 34:e1582. [PMID: 34669878 PMCID: PMC8521783 DOI: 10.1590/0102-672020210002e1582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/04/2021] [Indexed: 11/25/2022]
Abstract
Background: The surgical treatment of hyperhidrosis by thoracic sympathectomy has brought, in addition to symptomatic relief for many, its main adverse effect: compensatory or reflex sweating. The clipping technique in place of the sympathetic nerve section gave rise to the hope of reversibility, but the positive results showed to be quite divergent, evidencing the academic deficiency regarding the study of this phenomenon.
Aim: To observe micro and macroscopic damage caused by the polymer clip on sympathetic nerve of rabbits seven days after their clipping and the findings after three weeks of clip removal.
Method: In this experimental study, 20 rabbits were divided into two groups of 10, group 1 (clipping) and group 2 (de-clipping). The right cervical sympathetic nerve of all animals was clamped with polymeric clip, and in group 2 the nerve was unclipped seven days later. Group 1 rabbits were induced to death on the 7th postoperative day, and group 2 on the 21st after removal of the polymer clip. Macroscopic variables were: clip appearance, presence of discontinuity lesion, infection and adhesions around the nerve. H&E was used in the evaluation of the phases and degree of the inflammatory process and presence of necrosis, and picrosirius red F3BA for quantification of collagen.
Results: The cervical sympathetic nerve was intact, without necrosis or infection in all animals of the experiment; there were adhesions in both groups, being minimal in eight animals of each group and moderate or intense in two; the clip was completely closed in all animals at the 7th postoperative day; the inflammatory process shown was chronic, with monomorphonuclear predominance. There was no significant difference between groups regarding the intensity the inflammatory process, but the amount of collagen type I and type III was significantly higher in group 2.
Conclusions: The injury caused by the polymer clip on the sympathetic nerve may be reversible, allowing functional return in the areas involved in the simulated cervical sympathectomy. Clipping of the cervical sympathetic nerve using a polymer clip does not cause discontinuity injury.
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Affiliation(s)
| | - Nicolau Gregori Czeczko
- Mackenzie Evangelical Faculty of Paraná, Curitiba, PR, Brazil.,University Evangelical Mackenzie Hospital, Curitiba, PR, Brazil
| | | | | | - Jurandir Marcondes Ribas-Filho
- Mackenzie Evangelical Faculty of Paraná, Curitiba, PR, Brazil.,University Evangelical Mackenzie Hospital, Curitiba, PR, Brazil
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Yang C, Li Z, Bai H, Mao H, Li JX, Wu H, Wu D, Mu J. Long-Term Efficacy of T3 Versus T3+T4 Thoracoscopic Sympathectomy for Concurrent Palmar and Plantar Hyperhidrosis. J Surg Res 2021; 263:224-229. [PMID: 33691245 DOI: 10.1016/j.jss.2020.11.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 11/03/2020] [Accepted: 11/15/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND More than 50% of patients with palmar hyperhidrosis (PAH) also have plantar hyperhidrosis (PLH). We compared the long-term results of T3 sympathectomy with those of combined T3+T4 sympathectomy among patients with concurrent PAH and PLH. MATERIALS AND METHODS We retrospectively analyzed the records of patients with concurrent PAH and PLH who underwent T3 alone or T3+T4 sympathectomy from January 1, 2012, to December 31, 2017. Preoperative and postoperative sweating (hyperhidrosis index) was evaluated through questionnaires, physical examination, and outpatient follow-up. The relief rates and hyperhidrosis index were used as outcome measures to compare the efficacy of the two approaches. Patients' satisfaction and side effects were also evaluated. RESULTS Of the 220 eligible patients, 60 underwent T3 sympathectomy (T3 group), and 160 underwent T3+T4 sympathectomy (T3+T4 group). Compared with the T3 group, the T3+T4 group showed higher symptom relief rates both for PAH (98.75% versus 93.33%, P = 0.048) and PLH (65.63% versus 46.67%, P = 0.01), and a greater postoperative decrease in both hyperhidrosis indices. The rate of severe compensatory hyperhidrosis also increased (10% versus 5%, P = 0.197), although the rates of overall satisfaction were comparable between the groups. The incidence of postoperative pneumothorax requiring chest tube placement and postoperative neuralgia was also similar. There were no cases of perioperative death, secondary operation, wound infection, or Horner syndrome in either group. CONCLUSIONS Compared with T3 alone, T3+T4 sympathectomy achieved a higher symptom relief rate and a lower hyperhidrosis index. T3+T4 sympathectomy may be a choice for the treatment of concurrent PAH and PLH; however, patients need to be informed that this kind of surgery may increase the risk of compensatory sweating.
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Affiliation(s)
- Chenglin Yang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China; Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
| | - Zifan Li
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
| | - Huiwen Bai
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
| | - Hailong Mao
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
| | - Jie Xiong Li
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
| | - Hao Wu
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
| | - Da Wu
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China.
| | - Juwei Mu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.
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Rib-oriented Thoracoscopic Sympathetic Surgery for Hyperhidrosis: Prospective Long-term Results and Quality of Life. Surg Laparosc Endosc Percutan Tech 2021; 31:307-312. [PMID: 33605681 DOI: 10.1097/sle.0000000000000925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 12/03/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The optimal thoracoscopic sympathetic surgery for primary palmar and/or axillary hyperhidrosis (PPAH) is still unclear because of lack of uniform technique and qualitative/quantitative scales for definition of results. The aims of this study were to compare long-term outcomes based on the surgical technique and the level of sympathetic trunk interruption by clipping and to assess postoperative compensatory sweating (CS), patients' satisfaction, and quality of life (QoL). MATERIALS AND METHODS Between September 2009 and April 2016, 94 patients who underwent 2-stage bilateral thoracoscopic rib-oriented (R) sympathetic clipping were prospectively followed up through the administration of standardized preoperative and postoperative questionnaires.Thirty-four (36.2%) patients underwent single-port transaxillary access instead of the standard two 5-mm incisions. The level of sympathetic clipping for PPAH was R3+4(top and bottom); in patients who complained associated facial or plantar hyperhidrosis R2-bottom and R5-top were clipped, respectively. Seventy-five patients completed bilateral surgery. RESULTS There were no significant differences between single-port and biportal video-assisted thoracoscopic surgery in terms of operative times and postoperative results. At a mean follow-up of 72 (SD: 26) months, CS was reported in 42 (56%) patients, severe only in 6 (8%). It was higher in the case of R2-bottom clipping (P=0.03). Thirty-one of 60 (51.6%) patients who had a plantar hyperhidrosis declared an improvement of feet sweating after surgery. Postoperative satisfaction was excellent (86.11% on a 0 to 100 scale) and 95.4% of patients declared an improvement in QoL, which was statistically significant in all evaluated parameters. These results were not related to the level of clipping. CONCLUSION Thoracoscopic R3 to R4 clipping appears to be a safe and effective treatment for PPAH. Although postoperative CS was common and higher after R2-bottom clipping, this did not seem to affect patients' satisfaction and improvement in QoL.
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Vanaclocha V, Sáiz Sapena N, Rivera M, Herrera JM, Ortiz-Criado JM, Monzó-Blasco A, Guijarro-Jorge R, Vanaclocha L. Selective block of grey communicantes in upper thoracic sympathectomy. A feasibility study on human cadaveric specimens. Br J Neurosurg 2019; 34:362-369. [PMID: 31353968 DOI: 10.1080/02688697.2019.1645297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Sympathetic chain interruption is the gold standard treatment for essential hyperhidrosis. Postoperative compensatory hyperhidrosis, the main reason for patients' dissatisfaction, is reduced by selectively lesioning white and grey rami communicantes (ramicotomy).Objective: To develop an endoscopic surgical technique that interrupts only T3 and T4 grey rami communicantes to minimize compensatory hyperhidrosis.Material and Methods: T3 and T4 grey rami communicantes ramicotomy in fifteen cold-preserved cadavers through a uniportal axillary endoscopic approach. The sympathetic chain, its ganglia, and white rami communicantes were left intact. On opening the chest, the sympathetic chain, rami communicantes and ganglia were dissected, photographed, measured and excised for histological examination.Results: Dissecting the grey rami communicantes is feasible as they consistently lie between the intercostal nerve and the homonymous sympathetic ganglion. At some levels, Kuntz nerves, as well as more than one grey ramus communicans, can be found. White rami communicantes are more medial, therefore damaging them can be avoided. Intercostal veins can be obstructive, but these can be controlled via coagulation or clipping if necessary.Conclusion: Uniportal endoscopic selective excision of the T3 and T4 grey rami communicantes is feasible without damaging the white rami communicantes, the sympathetic chain or its ganglia. Clipping the grey rami communicantes is technically possible but not reliable due to their thin diameter. This study confirms that T3 and T4 grey rami sympathetic block is technically feasible. Its application might reduce compensatory hyperhidrosis, but clinical studies are needed.
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Affiliation(s)
- Vicente Vanaclocha
- Department of Neurosurgery, Hospital General Universitario de Valencia, Valencia, Spain
| | - Nieves Sáiz Sapena
- Department of Anesthesiology, Hospital 9 de Octubre de Valencia, Valencia, Spain
| | - Marlon Rivera
- Department of Neurosurgery, Hospital General Universitario de Valencia, Valencia, Spain
| | - Juan Manuel Herrera
- Department of Neurosurgery, Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | - Ricardo Guijarro-Jorge
- Department of Thoracic Surgery, Hospital General Universitario de Valencia, Valencia, Spain
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Kara M, Kose S, Ozkan B, Sertcakacilar G. Does clip removal help for compensatory hyperhidrosis complicating thoracic sympathetic clipping? Clin Auton Res 2019; 29:353-355. [PMID: 30859345 DOI: 10.1007/s10286-019-00599-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/26/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Murat Kara
- Istanbul University, Faculty of Medicine, Department of Thoracic Surgery, Istanbul, Turkey.
| | - Selcuk Kose
- Department of Thoracic Surgery, Bakirkoy Research and Training Hospital, Istanbul, Turkey
| | - Berker Ozkan
- Istanbul University, Faculty of Medicine, Department of Thoracic Surgery, Istanbul, Turkey
| | - Gokhan Sertcakacilar
- Department of Anesthesiology and Reanimation, Bakirkoy Research and Training Hospital, Istanbul, Turkey
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Fibla Alfara JJ, Molins López-Rodó L, Hernández Ferrández J, Guirao Montes Á. Effectiveness of bilateral clipping of the thoracic sympathetic chain for the treatment of severe palmar and/or axillary hyperhidrosis and facial flushing. Cir Esp 2019; 97:196-202. [PMID: 30685056 DOI: 10.1016/j.ciresp.2018.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/14/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Division of the thoracic sympathetic chain is the standard treatment for severe palmar and/or axillary hyperhidrosis and facial flushing. Clipping is an alternative option which allows the block to be reverted in cases of intolerable compensatory sweating. METHODS This is a prospective study performed to assess: a) results of clipping of the thoracic sympathetic chain in patients with palmar and/or axillary hyperhidrosis and facial flushing; and b) to determine the improvement obtained after removal of the clip in patients with unbearable compensatory sweating. We included 299 patients (598 procedures) diagnosed with palmar hyperhidrosis (n=110), palmar and/or axillary hyperhidrosis (n=78), axillary hyperhidrosis (n=35), and facial flushing (n=76), who underwent videothoracoscopic clipping between 2007 and 2015. RESULTS 128 men and 171 women were treated, with mean age of 28 years. A total of 290 patients (97.0%) were discharged within 24hours. The procedure was effective in 92.3% (99.1% in palmar hyperhidrosis, 96,1% in palmar and/or axillary hyperhidrosis, 74.3% in axillary hyperhidrosis, and 86.8% in facial flushing). Nine patients (3%) presented minor complications. Compensatory sweating developed in 137 patients (45.8%): moderate in 113 (37.8%), severe in 16 (5.3%) and unbearable in 8 (2.7%). The clip was removed in these 8 patients; symptoms improved in 5 (62.8%), with sustained effect on hyperhidrosis in 4 of them. CONCLUSIONS Clipping of the thoracic sympathetic chain is an effective and safe procedure. If incapacitating compensatory sweating develops, this technique allows the clips to be removed with reversion of symptoms in a considerable number of patients.
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Affiliation(s)
| | - Laureano Molins López-Rodó
- Cirugía Torácica, Hospital Universitari Sagrat Cor, Barcelona, España; Cirugía Torácica, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | | | - Ángela Guirao Montes
- Cirugía Torácica, Hospital Universitari Sagrat Cor, Barcelona, España; Cirugía Torácica, Hospital Clínic, Universitat de Barcelona, Barcelona, España
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Du X, Zhu X, Wang T, Hu X, Lin P, Teng Y, Fan C, Li J, Xi Y, Xiao J, Liu W, Zhang J, Zhou H, Tian D, Yuan S. Compensatory hyperhidrosis after different surgeries at the same sympathetic levels: a meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:203. [PMID: 30023366 DOI: 10.21037/atm.2018.05.24] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Different techniques of video-assisted thoracoscopic sympathetic surgery have become the radical treatments for palmar and axillary hyperhidrosis (AH). However, there is no consensus over which technique can make a minimal incidence of compensatory hyperhidrosis (CH). This study was designed to compare the incidence of CH after different techniques at the same sympathetic levels in the treatment of upper limb and facial hyperhidrosis (FH). Methods The databases of PubMed, Web of Science, ScienceDirect, Ovid Medline, Embase, and Cochrane Library were searched to identify studies comparing different surgical techniques at the same sympathetic levels for upper limb and FH. The data was analyzed by Revman 5.3 software. Results A total of ten studies involving 896 patients were included, of whom 149 underwent sympathectomy, 435 underwent sympathicotomy, and 312 under endoscopic sympathetic clip (ESC). Meta-analysis showed that the difference of incidence of CH and patients' satisfaction was not significant between sympathectomy and sympathicotomy (P=0.05, 0.19, respectively). But, the incidence of CH is significant lower after ESC than after sympathicotomy (OR: 1.58, 95% CI: 1.04-2.38, P=0.03). However, the incidence of moderate/severe CH between these two groups is not significant different (OR: 1.49, 95% CI: 0.93-2.39, P=0.10). Conclusions If only CH and the same sympathetic levels concerned, sympathectomy and sympathicotomy is equal for upper limb hyperhidrosis and FH. And, ESC should be recommended for a lower incidence of CH, comparing with sympathicotomy.
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Affiliation(s)
- Xiaojun Du
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Xu Zhu
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Tao Wang
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Xiao Hu
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Peng Lin
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Yin Teng
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Chao Fan
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Jianglun Li
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Yang Xi
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Jiarong Xiao
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Wen Liu
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Jian Zhang
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Haiyu Zhou
- Department of Thoracic Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Dan Tian
- Department of Thoracic Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Shizhang Yuan
- Department of Thoracic Surgery, Guiyang Public Health Clinical Center, Guiyang 550003, China
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Wolosker N, Milanez de Campos JR, Fukuda JM. Management of Compensatory Sweating After Sympathetic Surgery. Thorac Surg Clin 2016; 26:445-451. [DOI: 10.1016/j.thorsurg.2016.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Endoscopic thoracic sympathectomy (ETS) is an effective treatment of primary hyperhidrosis of the face, upper extremities, and axillae. The major limitation is the side effect of compensatory sweating severe enough that patients request reversal in up to 10% of cases. When ETS is performed by cutting the sympathetic chain, reversal requires nerve grafting. However, for ETS done with clips, reversal is a simple thoracoscopic outpatient procedure of removing the clips. Subsequent reversal of the sympathectomy, ie, nerve regeneration, is successful in many cases. However, follow-up is short. Factors contributing to success rates require further study.
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Joo S, Lee GD, Haam S, Lee S. Comparisons of the clinical outcomes of thoracoscopic sympathetic surgery for palmar hyperhidrosis: R4 sympathicotomy versus R4 sympathetic clipping versus R3 sympathetic clipping. J Thorac Dis 2016; 8:934-41. [PMID: 27162669 DOI: 10.21037/jtd.2016.03.57] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Thoracoscopic sympathetic surgery is regarded as a definitive treatment for palmar hyperhidrosis. However, the optimal surgical strategy remains unclear. The aim of this study was to compare outcomes based on the level and type of sympathetic disconnection in patients with palmar hyperhidrosis. METHODS From January 2009 to December 2014, 101 patients with palmar hyperhidrosis underwent thoracoscopic sympathetic surgery at Gangnam Severance Hospital. Complete follow-up information was obtained from 59 patients. We retrospectively analyzed the results of operation, degree of palmar sweating (%), grade of compensatory sweating (none, mild, moderate, severe, very severe), grade of satisfaction (very satisfied, satisfied, moderate, dissatisfied, very dissatisfied), and recurrence/failure. RESULTS R4 sympathicotomy, R4 sympathetic clipping, and R3 sympathetic clipping were performed in 16, 20, and 23 patients, respectively. The mean degree of palmar sweating after sympathetic surgery was not significantly different between these three groups (17.50% vs. 27.00% vs. 29.78%; P=0.38). The rate of life-bothering compensatory sweating was lower in the R4 sympathicotomy group compared with those of other two groups (0% vs. 25%, 47.8%; P=0.09). The rate of very satisfied to moderate grades of satisfaction were lower in the R3 sympathetic clipping group compared with those of other two groups (93.8%, 100% vs. 73.9%; P=0.07). The rate of recurrence/failure rates were lower in the R4 sympathicotomy group compared with those of other two groups (12.50% vs. 35.00%, 34.8%; P=0.25). Sympathetic surgery at the R3 level was the only significant risk factor for patient dissatisfaction (odd ratio =12.353, 95% confidence interval =1.376-110.914; P=0.025). CONCLUSIONS Our data support that R4 sympathicotomy had lower grades of compensatory sweating, higher grades of satisfaction, and lower rates of recurrence/failure. We therefore consider R4 sympathicotomy as an optimal surgical treatment for palmar hyperhidrosis.
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Affiliation(s)
- Seok Joo
- 1 Department of Trauma Surgery, Regional Trauma Center, Gachon University Gil Hospital, Incheon, Republic of Korea ; 2 Department of Thoracic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Geun Dong Lee
- 1 Department of Trauma Surgery, Regional Trauma Center, Gachon University Gil Hospital, Incheon, Republic of Korea ; 2 Department of Thoracic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seokjin Haam
- 1 Department of Trauma Surgery, Regional Trauma Center, Gachon University Gil Hospital, Incheon, Republic of Korea ; 2 Department of Thoracic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungsoo Lee
- 1 Department of Trauma Surgery, Regional Trauma Center, Gachon University Gil Hospital, Incheon, Republic of Korea ; 2 Department of Thoracic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Street E, Ashrafi M, Greaves N, Gouldsborough I, Baguneid M. Anatomic Variation of Rami Communicantes in the Upper Thoracic Sympathetic Chain: A Human Cadaveric Study. Ann Vasc Surg 2016; 34:243-9. [PMID: 27116906 DOI: 10.1016/j.avsg.2016.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 02/06/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hyperhidrosis is secondary to over activation of the sympathetic nervous system and surgical sympathectomy is the treatment of choice when other modalities have failed. This study investigated anatomic variation in the upper thoracic sympathetic chain and associated rami communicantes among cadaveric specimens. It considers the implications of these findings on surgical techniques to treat hyperhidrosis. METHODS The upper 4 thoracic sympathetic ganglia, intercostal nerves, and connecting rami were dissected, measured and mapped in 40 sides of 20 adult human cadavers. Ganglia location was recorded. The incidence, orientation, and distance travelled by rami communicantes was compared across different ganglionic levels and between sides. RESULTS The percentage of ganglia located below their associated intercostal space was 6.25% with stellate ganglions present in 70% of specimens and Kuntz fibers noted in 40%. There was a stepwise reduction in incidence of rami from superior to inferior placed ganglia. The number of rami identified across all levels was significantly greater on the right (P = 0.03). The horizontal distance between the sympathetic chain and union of the rami on the intercostal nerves was significantly greater on the right across all levels (P = 0.04). CONCLUSIONS There was substantial variation in the rami communicantes across the upper 4 ganglia and between right and left sides. Consideration of this variation should be given when planning surgical sympathectomy for hyperhidrosis particularly to avoid symptom recurrence.
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Affiliation(s)
- Elliot Street
- Department of Vascular Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Mohammed Ashrafi
- Department of Vascular Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Nicholas Greaves
- Department of Vascular Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | | | - Mohamed Baguneid
- Department of Vascular Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
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