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Kuijpers M, Peeters G, Harms PW, Bouma W, DeJongste MJ, Mariani MA, Klinkenberg TJ. Bilateral one-stage single-port sympathicotomy in primary focal hyperhidrosis, a prospective cohort study: treat earlier? J Cardiothorac Surg 2021; 16:50. [PMID: 33766091 PMCID: PMC7992325 DOI: 10.1186/s13019-021-01430-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Primary Focal Hyperhidrosis (PFH) has a detrimental effect on Quality of Life. Repetitive, non-curative symptomatic strategies dominate current treatment of PFH, in spite of the availability of an effective and permanent curative treatment like Endoscopic Thoracic Sympathectomy (ETS). Current surgical optimization may allow for a re-established position of sympathetic modulation in this treatment algorithm. We sought to evaluate the safety, effectiveness, and long-term results of a Bilateral One-stage Single-port Sympathicotomy (BOSS) procedure in PFH patients and to identify subgroups benefitting most. Methods Prospective analysis of 163 patients, 35 (21.5%) underwent Rib-3 (R3) BOSS for palmar PFH, 58 (35.6%) R3-R5 BOSS for axillary PFH and 70 (42.9%) R3-R5 BOSS for combined palmar/axillary PFH. Effectiveness was measured using Skindex-29 and the Hyperhidrosis Disease Severity Scale (HDSS). Results Overall Skindex-29-rating (46.5 ± 14.8 preoperatively vs 20.1 ± 20.6 postoperatively, p < 0.001), and HDSS score (3.71 ± 0.45 preoperatively vs 1.82 ± 0.86 postoperatively, p < 0.001) indicated a significant improvement in health-related quality of life after BOSS. R3 BOSS was superior to R3-R5 BOSS in terms of HDSS score (1.49 vs 1.91 respectively, p = 0.004) and in terms of severe compensatory hyperhidrosis, a frequently reported side-effect (17.1% vs 32.8% respectively, p < 0.001). No major complications occurred. Conclusions BOSS is safe, effective, and offers a long-term curative solution in the treatment of PFH. Especially in the palmar PFH subgroup, R3 BOSS treatment results compare favorably to the treatment results of non-curative alternatives published in the current literature. Therefore, R3 BOSS should be offered to all patients with severe PFH, reporting insufficient benefit of treatment options such as oral and/or local agents.
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Affiliation(s)
- Michiel Kuijpers
- Department of Cardiothoracic Surgery, University Medical Center Groningen, AB32, Postbus 30.001, Groningen, 9700, RB, The Netherlands. .,Hyperhidrosis Expert Center, Dermatology, Martini Hospital, Groningen, The Netherlands.
| | - Gwen Peeters
- Department of Cardiothoracic Surgery, University Medical Center Groningen, AB32, Postbus 30.001, Groningen, 9700, RB, The Netherlands
| | - Petra W Harms
- Hyperhidrosis Expert Center, Dermatology, Martini Hospital, Groningen, The Netherlands
| | - Wobbe Bouma
- Department of Cardiothoracic Surgery, University Medical Center Groningen, AB32, Postbus 30.001, Groningen, 9700, RB, The Netherlands.,Hyperhidrosis Expert Center, Dermatology, Martini Hospital, Groningen, The Netherlands
| | | | - Massimo A Mariani
- Department of Cardiothoracic Surgery, University Medical Center Groningen, AB32, Postbus 30.001, Groningen, 9700, RB, The Netherlands
| | - Theo J Klinkenberg
- Department of Cardiothoracic Surgery, University Medical Center Groningen, AB32, Postbus 30.001, Groningen, 9700, RB, The Netherlands.,Hyperhidrosis Expert Center, Dermatology, Martini Hospital, Groningen, The Netherlands
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Verhaegh AJFP, Kuijpers M, Boon M, DeJongste MJL, Bouma W, Mariani MA, Klinkenberg TJ. Thoracoscopic sympathicotomy for the treatment of intolerable palmar and axillary hyperhidrosis in children is associated with high recurrence rates. Pediatr Dermatol 2020; 37:987-992. [PMID: 32677080 PMCID: PMC7586985 DOI: 10.1111/pde.14273] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Treatment of palmar and axillary primary focal hyperhidrosis (PFH) in children up to 16 years using thoracoscopic sympathicotomy is supported by scarce evidence. Therefore, this study aimed to summarize the results of our standardized bilateral, one-stage, single-port sympathicotomy (BOSS) in children up to 16 years of age. METHODS Consecutive children (n = 14) up to 16 years of age undergoing BOSS between October 2011 and June 2015 in our institution were included in this retrospective study. RESULTS Recurrence of primary hyperhidrosis was noted in seven patients (50.0%), of whom five patients (35.7%) underwent reoperation. Reoperations were associated with placement of additional thoracoscopic ports (n = 1; 12.5%), intraoperative placement of pleural drains (n = 2; 25%), and prolonged air leak (n = 1; 12.5%). Despite the high recurrence and reoperation rates, overall patient satisfaction was high with a median satisfaction score of 7.5 (interquartile range of 1.75; range: 4-9). CONCLUSION Although the overall patient satisfaction score in our cohort was good, BOSS for the treatment of intolerable palmar and axillary PFH in children up to 16 years of age is associated with a high recurrence and reoperation rate.
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Affiliation(s)
- Arjan J F P Verhaegh
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel Kuijpers
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maartje Boon
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mike J L DeJongste
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wobbe Bouma
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Massimo A Mariani
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Theo J Klinkenberg
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Divisi D, Zaccagna G, Imbriglio G, Di Francescantonio W, De Vico A, Barone M, Crisci R. Video-assisted thoracoscopic sympathectomy versus modified Wittmoser method in surgical management of primary hyperhidrosis. J Cardiothorac Surg 2020; 15:133. [PMID: 32522214 PMCID: PMC7285583 DOI: 10.1186/s13019-020-01176-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/31/2020] [Indexed: 11/24/2022] Open
Abstract
Purposes We compared two different surgical methods evaluating the effectiveness of procedures and the quality of life (QoL) of patients. Methods From January 2010 to November 2017 we carried out 476 biportal video-assisted thoracoscopic surgery (VATS) approaches of sympathetic chain in 238 patients. One hundred and twenty-nine (54%) patients underwent conventional sympathectomy (CS) while 109 (46%) patients underwent sympathicotomy associated with the division of the rami communicantes (MWT). Quality of Life (QoL) was classified as follows: from 20 to 35 excellent; from 36 to 51 very good; from 52 to 68 good; from 69 to 84 poor; and > 84 very poor. Results We noticed statistical significant reduction of complications comparing CS with MWT approaches (chest pain from 36.4 to 4.5%; paresthesias from 8.5 to 3.6%; bradycardia from 28.6 to 10%, respectively). The preoperative and postoperative QoL index evaluation revealed a statistically significant improvement after surgery (CS: 86 ± 2 versus 35 ± 1, p = 0.00001; MWT: 85 ± 1 versus 33 ± 2, p = 0.00001), with general satisfaction of the two techniques. Conclusion Modified Wittmoser method seems to be a valid alternative to conventional sympathectomy, minimizing the percentage rate of complications and showing significant effectiveness in the quality of life improvement.
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Affiliation(s)
- Duilio Divisi
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, 64100, Teramo, Italy.
| | - Gino Zaccagna
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, 64100, Teramo, Italy
| | - Giovanna Imbriglio
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, 64100, Teramo, Italy
| | - William Di Francescantonio
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, 64100, Teramo, Italy
| | - Andrea De Vico
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, 64100, Teramo, Italy
| | - Mirko Barone
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, 64100, Teramo, Italy
| | - Roberto Crisci
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, 64100, Teramo, Italy
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Shi H, Shu Y, Shi W, Lu S, Sun C. Single-Port Microthoracoscopic Sympathicotomy for the Treatment of Primary Palmar Hyperhidrosis: an Analysis of 56 Consecutive Cases. Indian J Surg 2015; 77:270-5. [PMID: 26702233 DOI: 10.1007/s12262-015-1288-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022] Open
Abstract
The objective of this study is to investigate the feasibility and safety of single-port microthoracoscopic thoracic sympathicotomy for the treatment of palmar hyperhidrosis. Between January 2008 and March 2013, 56 patients (36 male, 20 female; mean age 25.6 years, age range 16-39 years) underwent single-port microthoracoscopic thoracic sympathicotomy for palmar hyperhidrosis. Nineteen patients (33.9 %) had moderate palmar hyperhidrosis that could thoroughly wet a handkerchief, and 37 (66.1 %) had severe palmar hyperhidrosis with sweat dripping from the palm. Eight patients (14.3 %) had a positive family history, 34 (60.7 %) had plantar hyperhidrosis, 22 (39.3 %) had axillary hyperhidrosis, and 20 (35.7 %) had both plantar and axillary hyperhidrosis. In addition, 21 patients (37.5 %) had palmar pompholyx, five (8.9 %) had keratolysis exfoliativa, 10 (17.9 %) had chilblains, and nine (16.1 %) had palmar rhagades. A single 10-mm skin incision was made in the third intercostal space at the anterior axillary line, posterior to the pectoralis muscle. A 5-mm microthoracoscope and a 3-mm microelectrocautery hook were inserted through a single port into the thoracic cavity. The third and fourth ribs were identified, and the sympathetic chain was cut using the microelectrocautery hook. The bypassing nerve fibers, such as the Kuntz nerve fiber bundle, were ablated for 2-3 cm along the surface of the rib. The palmar temperature was recorded before and after sympathicotomy. All 56 procedures were completed using single-port microthoracoscopy. No postoperative complications such as hemorrhage, wound infection, hemopneumothorax, bradycardia, or Horner's syndrome were observed. Bilateral procedures were completed in 20-56 min (mean 30 min). The palmar temperature increased by 2.2 ± 0.3 °C after surgery. The postoperative hospital stay was 1-4 days (mean 2.5 days). Mild compensatory sweating of the back and thigh occurred in five patients (8.9 %) at 2-3 days after surgery and disappeared at 7-15 days. The patients were followed up for 28.5 months (range 1-62 months). Hyperhidrosis resolved in both hands after surgery, and the previously wet, cold hands became dry and warm. The efficacy rate was 100 %. Plantar hyperhidrosis was also significantly reduced in 33 of the 34 patients with this condition (remission rate 97.1 %), and axillary hyperhidrosis was significantly reduced in 19 of 22 patients (remission rate 86.4 %). Eighteen of the 20 patients (90.0 %) with both plantar and axillary hyperhidrosis experienced significant alleviation of their symptoms. Single-port microthoracoscopic thoracic sympathicotomy is a safe, convenient, and effective method of treating palmar hyperhidrosis. This procedure can accurately locate the sympathetic chain with a small incision, minimal invasiveness, and good cosmetic results. The procedure is suitable for extensive clinical use.
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Affiliation(s)
- Hongcan Shi
- Department of Cardiothoracic Surgery, Clinical College, Yangzhou University, 11 Huaihai Road, Yangzhou, 225001 Jiangsu Province People's Republic of China
| | - Yusheng Shu
- Department of Cardiothoracic Surgery, Clinical College, Yangzhou University, 11 Huaihai Road, Yangzhou, 225001 Jiangsu Province People's Republic of China
| | - Weiping Shi
- Department of Cardiothoracic Surgery, Clinical College, Yangzhou University, 11 Huaihai Road, Yangzhou, 225001 Jiangsu Province People's Republic of China
| | - Shichun Lu
- Department of Cardiothoracic Surgery, Clinical College, Yangzhou University, 11 Huaihai Road, Yangzhou, 225001 Jiangsu Province People's Republic of China
| | - Chao Sun
- Department of Cardiothoracic Surgery, Clinical College, Yangzhou University, 11 Huaihai Road, Yangzhou, 225001 Jiangsu Province People's Republic of China
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Nachira D, Chiappetta M, Mastromarino MG, Congedo MT, Vita ML, Porziella V, Meacci E, Margaritora S, Granone P. Looking for a standardized approach in the surgical treatment of hyperhidrosis. Clin Auton Res 2015; 25:343. [PMID: 26419239 DOI: 10.1007/s10286-015-0311-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/29/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Dania Nachira
- Department of General Thoracic Surgery, Catholic University, Rome, Italy.
| | - Marco Chiappetta
- Department of General Thoracic Surgery, Catholic University, Rome, Italy
| | | | | | - Maria Letizia Vita
- Department of General Thoracic Surgery, Catholic University, Rome, Italy
| | - Venanzio Porziella
- Department of General Thoracic Surgery, Catholic University, Rome, Italy
| | - Elisa Meacci
- Department of General Thoracic Surgery, Catholic University, Rome, Italy
| | | | - Pierluigi Granone
- Department of General Thoracic Surgery, Catholic University, Rome, Italy
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Kuijpers M, Klinkenberg TJ, Bouma W, DeJongste MJ, Mariani MA. Single-port one-stage bilateral thoracoscopic sympathicotomy for severe hyperhidrosis: prospective analysis of a standardized approach. J Cardiothorac Surg 2013; 8:216. [PMID: 24279511 PMCID: PMC4222053 DOI: 10.1186/1749-8090-8-216] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 11/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary palmar and/or axillary focal hyperhidrosis is a frequent disorder characterized by excessive sweating beyond physiological needs, often leading to a substantial impairment of quality of life. Over the years several minimally invasive surgical treatments have been described, however results vary, and due to a lack of uniform surgical approach, technique and nomenclature are often difficult to compare. In this prospective study we sought to evaluate the safety and effectiveness of our standardized technique of single-port, one-stage bilateral thoracoscopic sympathicotomy. METHODS On a prospective basis a hundred consecutive patients with severe or intolerable primary hyperhidrosis underwent one-stage bilateral single-port thoracoscopic sympathicotomy. Primary outcome was measured in pre- vs. post-operative Hyperhidrosis Disease Severity Scale scores. Location and extend of compensatory hyperhidrosis, and satisfaction with the procedure were registered. RESULTS A significant reduction in mean Hyperhidrosis Disease Severity Scale score (3.69 ± 0.47 preoperatively vs. 1.06 ± 0.34 postoperatively) (p < 0.001) was observed. In 97 (97%) out of the 100 enrolled patients a >80% reduction in sweat production was achieved. Compensatory hyperhidrosis was seen in 27 patients (27%). It was rated as mild by 21 patients (78%) and as moderate by 6 (22%) of these patients. No severe compensatory hyperhidrosis was reported. Major complications, such as intraoperative bleeding, infections, and Horner's syndrome were not observed. CONCLUSIONS Highly selective sympathicotomy at well-defined levels with a one-stage bilateral single-port transaxillary thoracoscopic approach is a save procedure, with excellent and reproducible immediate results in the treatment of primary palmar and/or axillary hyperhidrosis.
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Affiliation(s)
- Michiel Kuijpers
- Department of Cardiothoracic Surgery, University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Theo J Klinkenberg
- Department of Cardiothoracic Surgery, University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Wobbe Bouma
- Department of Cardiothoracic Surgery, University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Mike J DeJongste
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Massimo A Mariani
- Department of Cardiothoracic Surgery, University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
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Lee R, Lomas O, Handa A. Severe Raynaud's phenomenon-A streamlined approach to acute management. Int J Surg Case Rep 2011; 2:61-3. [PMID: 26902555 DOI: 10.1016/j.ijscr.2011.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 01/31/2011] [Accepted: 02/03/2011] [Indexed: 10/18/2022] Open
Abstract
Raynaud's phenomenon is an exaggerated vasospastic response to cold or emotional stress which not only may cause the patient severe pain but also critical ischaemia and necrosis of the digits. We report the case of a 69-year-old woman who presented with rest pain, impending ulceration and necrosis of finger tips due to an episode of left-sided Raynaud's phenomenon. Intravenous prostacyclin was administered successfully as a bridge to endoscopic thoracic sympathectomy. Vascular surgery units are ideally positioned for the acute management of severe Raynaud's phenomenon to provide continuity of care to patients with profound digital ischaemia and impending tissue loss.
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Affiliation(s)
- Regent Lee
- Department of Vascular Surgery, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom.
| | - Oliver Lomas
- Department of Vascular Surgery, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom
| | - Ashok Handa
- Department of Vascular Surgery, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom
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Bouma W, Klinkenberg TJ, Mariani MA. Bilateral single-port thoracoscopic sympathectomy with the VasoView® device in the treatment of palmar and axillary hyperhidrosis☆. Interact Cardiovasc Thorac Surg 2011; 12:106-9. [PMID: 21051380 DOI: 10.1510/icvts.2010.252189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Wobbe Bouma
- Department of Cardiothoracic Surgery, University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
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9
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T3/T4 thoracic sympathictomy and compensatory sweating in treatment of palmar hyperhidrosis. Chin Med J (Engl) 2007. [DOI: 10.1097/00029330-200709020-00003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Licht PB, Jørgensen OD, Ladegaard L, Pilegaard HK. Thoracoscopic sympathectomy for axillary hyperhidrosis: the influence of T4. Ann Thorac Surg 2006; 80:455-9; discussion 459-60. [PMID: 16039185 DOI: 10.1016/j.athoracsur.2005.02.054] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Revised: 02/07/2005] [Accepted: 02/14/2005] [Indexed: 11/21/2022]
Abstract
BACKGROUND Recent data suggest that severe compensatory sweating after sympathectomy for hyperhidrosis is more common than previously reported. In particular, T2-T4 sympathectomy for axillary hyperhidrosis leads to significantly more disabling sweating compared with T2-T3 sympathectomy for palmar hyperhidrosis. However, it is not known whether this is a result of the additional transection of the T4 segment or if patients with primary axillary hyperhidrosis are more prone to experience disabling compensatory sweating. METHODS A follow-up study by questionnaire was made of 100 consecutive patients who underwent thoracoscopic sympathectomy for axillary hyperhidrosis at two university hospitals. Patients underwent T2-T3 sympathectomy (n = 35) or T2-T4 sympathectomy (n = 65) depending on the surgeon's preference. RESULTS The questionnaire was returned by 91% of patients after a median of 31 months. Compensatory sweating occurred in 90% of patients and was so severe in 61% that they often had to change clothes during the day. There were no significant differences in occurrence or severity of compensatory sweating between the two extents of sympathectomy. Surgical outcome, however, was significantly better after T2-T4 sympathectomy. CONCLUSIONS In contrast with previous reports, the incidence of compensatory sweating was not significantly related to the extent of sympathectomy for axillary hyperhidrosis. This result suggests that patients with primary axillary hyperhidrosis are more prone to experience compensatory sweating. Although the majority of patients with axillary hyperhidrosis were satisfied after thoracoscopic sympathectomy, many regret the operation. Patients should undergo surgery only if medical treatments fail; and provided there is an indication, we recommend T2-T4 sympathectomy.
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Affiliation(s)
- Peter B Licht
- Department of Cardiothoracic Surgery, Skejby Sygehus, Aarhus University Hospital, Aarhus, Denmark.
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Eisenach JH, Atkinson JLD, Fealey RD. Hyperhidrosis: evolving therapies for a well-established phenomenon. Mayo Clin Proc 2005; 80:657-66. [PMID: 15887434 DOI: 10.4065/80.5.657] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The socially embarrassing disorder of excessive sweating, or hyperhidrosis, and its treatment options are gaining widespread attention. In order of frequency, palmar-plantar, palmar-axillary, Isolated axillary, and cranlofacial hyperhidrosis are distinct disorders of sudomotor regulation. A common link among these disorders is an excessive, nonthermoregulatory sweat response often to emotional stimuli in body regions influenced by the anterior cingulate cortex as opposed to the thermoregulatory sweat response regulated by the preoptic-anterior hypothalamus. Diagnosis of these mechanistically ambiguous disorders is primarily from patient history and physical examination, whereas results of laboratory studies performed with indicator powder reveal the distribution and severity of resting hyperhidrosis and document the integrity of thermoregulatory sweating. Treatment options lie on a continuum based on the severity of hyperhidrosis and the risks and benefits of therapy. In general, therapy begins with antiperspirants or anticholinergics. Iontophoresis is available for palmar-plantar and axillary hyperhidrosis. Botulinum toxin type A or local excision/curettage is effective for isolated axillary hyperhidrosis not responsive to topical application of aluminum chloride. Endoscopic thoracic sympathectomy may be used for severe cases of palmar-plantar and palmar-axillary hyperhidrosis. No sole therapy of choice has emerged for craniofacial sweating. The long-term sequelae of hyperhidrosis and its treatment also are discussed.
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Affiliation(s)
- John H Eisenach
- Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
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Abstract
The treatment of focal hyperhidrosis and drooling with neurolysis of the neuroglandular junction is a relatively new and useful technique for managing such obvious conditions and improving the patient's quality of life. The treatment is safe, minimally invasive, and an effective alternative to other treatment modalities.
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Affiliation(s)
- Ib R Odderson
- Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA.
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13
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Doblas M, Gutierrez R, Fontcuberta J, Orgaz A, Lopez P, Criado E. Thoracodorsal sympathectomy for severe hyperhydrosis: posterior bilateral versus unilateral staged sympathectomy. Ann Vasc Surg 2003; 17:97-102. [PMID: 12545254 DOI: 10.1007/s10016-001-0343-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to compare the results of simultaneous bilateral thoracodorsal sympathectomy in the prone position with those of anterolateral sympathectomy performed in two staged, separate procedures for the treatment of bilateral excessive sweating of the hands and axillae, and to describe our technique for bilateral, simultaneous thoracodorsal sympathectomy. From July 1995 to March 2001, 202 thoracodorsal sympathectomies were done in 101 patients for severe hyperhydrosis. There were 79 females (age range 20-46) and 22 males (age range 19-65). In 52 patients, anterolateral sympathectomies were performed in the supine position, using unilateral lung collapse, with both sides operated on in two separate, staged procedures. In 49 patients, bilateral sympathectomy was conducted during a single procedure, in the prone position, without using unilateral lung collapse. In comparing the results from these two methods, we concluded that simultaneous bilateral thoracodorsal posterior sympathectomy, has comparable safety, may improve outcome, decreases in half the number of hospital admissions, and produces a significant overall reduction in cost when compared with staged anterolateral sympathectomy for the treatment of severe hyperhydrosis.
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Affiliation(s)
- Manuel Doblas
- Vascular Surgery Unit, Complejo Hospitalario de Toledo, Toledo, Spain.
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14
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Abstract
BACKGROUND Primary palmar hyperhidrosis is a condition marked by excessive perspiration and is reported to have an incidence of 1% in the Western population. It is a potentially disabling disorder that interferes with social, psychological, and professional activities. Over the past several years, several investigators have reported a positive family history in their patients treated for hyperhidrosis. To date, the cause is unknown; furthermore, epidemiologic data are scarce and inadequate. METHODS To characterize the genetic contribution to hyperhidrosis, we conducted a prospective study of 58 consecutive patients with palmar, plantar, or axillary hyperhidrosis treated with thoracoscopic sympathectomy from September 1993 to July 1999. Forty-nine of the 58 probands volunteered family history data for these analyses (84% response rate). A standardized questionnaire was administered during the postoperative visit or by phone interview, and a detailed family history was obtained. The same questionnaire was also administered to a set of 20 control patients. The familial aggregation of hyperhidrosis has been quantified by estimating the recurrence risks to the offspring, parents, siblings, aunts, uncles, and cousins of 49 probands and 20 controls. We estimated the penetrance by use of a genetic analysis program. RESULTS Thirty-two of 49 (65%) reported a positive family history in our hyperhidrosis group, and 0% reported a positive family history in our control group. A recurrence risk of 0.28 in the offspring of probands compared with frequency of 0.01 in the general population provides strong evidence for vertical transmission of this disorder in pedigrees and is further supported by the 0.14 risk to the parents of the probands. The results indicate that the disease allele is present in about 5% of the population and that one or two copies of the allele will result in hyperhidrosis 25% of the time, whereas the normal allele will result in hyperhidrosis less than 1% of the time. CONCLUSIONS We conclude that primary palmar hyperhidrosis is a hereditary disorder, with variable penetrance and no proof of sex-linked transmission. However, this does not exclude other possible causes, and we anticipate that genetic confirmation of this disorder may lead to earlier diagnoses and advances in medical and psychosocial interventions.
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Affiliation(s)
- Kyung M Ro
- University of California at Davis School of Medicine, Los Angeles, USA
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