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Lima SO, Neto JM, Fontes LM, Galrão de Almeida Figueiredo MB, Santos JM, Santana VR. Evaluation of quality of life (QOL) of young patients with primary hyperhidrosis (PH) before and after endoscopic thoracic sympathectomy (ETS). J Am Acad Dermatol 2023; 88:e197-e201. [PMID: 37069802 DOI: 10.1016/j.jaad.2015.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/23/2015] [Accepted: 10/30/2015] [Indexed: 04/19/2023]
Abstract
BACKGROUND Primary hyperhidrosis (PH) affects young patients and may cause emotional distress and a negative quality of life (QOL). OBJECTIVE We sought to evaluate the QOL of children and adolescents with PH treated by endoscopic thoracic sympathectomy. METHODS A study of 220 patients was performed, based on submitted QOL questionnaires from their first consultation. Patients were evaluated within 1 week and 24 months after surgery. RESULTS Before endoscopic thoracic sympathectomy, the QOL in relation to PH was declared very poor by 141 patients, and poor by the remaining 79 (P = .552). Postoperative cure was reported in 100% of palmar and axillary PH cases, and in 91.7% of facial PH. After 24 months, the QOL was described as much better by 212 patients, a little better by 6 patients, and 2 patients reported no change. LIMITATIONS Convenience sampling was used and patients were taken from private practice only, raising the possibility of bias in gathering the data. CONCLUSION Onset of PH symptoms was mainly before the age of 10 years and substantially affected daily activities. Endoscopic thoracic sympathectomy cured PH and promoted significant improvement in the QOL of these young patients.
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Hong Z, Wu X, Sheng Y, Cui B, Bai X, Lu Y, Cheng T, Jin D, Gou Y. Comparison of the efficacy of ETS with different segments for palmar, axillary and plantar hyperhidrosis. BMC Surg 2023; 23:82. [PMID: 37041509 PMCID: PMC10091614 DOI: 10.1186/s12893-023-01976-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 03/28/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND To compare the near and long-term outcomes of endoscopic thoracic sympathectomy (ETS) for palmar, axillary and plantar hyperhidrosis. METHODS We retrospectively analyzed the clinical data of 218 patients with hyperhidrosis who were admitted to the Department of Thoracic Surgery of Gansu Provincial People's Hospital for surgical treatment from April 2014 to August 2021. The patients were divided into three groups according to the method of ETS and the perioperative clinical data and postoperative follow-up data were collected to compare the near and long term outcomes of the three groups. RESULTS There were 197 eligible patients at follow-up, 60 patients in the R4 cut-off group, 95 patients in the R3 + R4 cut-off group and 42 patients in the R4 + R5 cut-off group. There were no statistically significant differences in baseline indicators such as sex, age and positive family history among the three groups (P > 0.05). There was no statistically significant difference between the three groups in terms of operative time (P = 0.148), intraoperative bleeding (P = 0.308) and postoperative hospital stay (P = 0.407). Postoperatively, all three groups showed significant relief of palmar hyperhidrosis symptoms, with the R3 + R4 group having an advantage in terms of relief of axillary hyperhidrosis symptoms, patient satisfaction and quality of life index at 6 months postoperatively and the R4 + R5 group having an advantage in terms of relief of plantar hyperhidrosis symptoms. The difference in compensatory hyperhidrosis at 12 months postoperatively was not statistically significant among the three groups (P = 0.867), but the incidence was higher in the R3 + R4 and R4 + R5 groups than that in the R4 group. CONCLUSION Patients with simple palmar hyperhidrosis can first consider R4 cut-off treatment; R3 + R4 cut-off is more effective in treating palmar hyperhidrosis combined with axillary hyperhidrosis; R4 + R5 cut-off is more effective in treating palmar hyperhidrosis combined with plantar hyperhidrosis. However, patients need to be informed that R3 + R4 and R4 + R5 dissection may increase the risk of severe compensatory hyperhidrosis after surgery.
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Affiliation(s)
- Ziqiang Hong
- The First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, 35 East Dingxi Road, Lanzhou, Gansu, 730000, China
- First Department of Thoracic Surgery, Gansu Provincial Hospital, 204 Donggang West Road, Lanzhou, Gansu, 730000, China
| | - Xusheng Wu
- The First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, 35 East Dingxi Road, Lanzhou, Gansu, 730000, China
- First Department of Thoracic Surgery, Gansu Provincial Hospital, 204 Donggang West Road, Lanzhou, Gansu, 730000, China
| | - Yannan Sheng
- The First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, 35 East Dingxi Road, Lanzhou, Gansu, 730000, China
| | - Baiqiang Cui
- The First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, 35 East Dingxi Road, Lanzhou, Gansu, 730000, China
- First Department of Thoracic Surgery, Gansu Provincial Hospital, 204 Donggang West Road, Lanzhou, Gansu, 730000, China
| | - Xiangdou Bai
- The First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, 35 East Dingxi Road, Lanzhou, Gansu, 730000, China
- First Department of Thoracic Surgery, Gansu Provincial Hospital, 204 Donggang West Road, Lanzhou, Gansu, 730000, China
| | - Yingjie Lu
- The First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, 35 East Dingxi Road, Lanzhou, Gansu, 730000, China
| | - Tao Cheng
- The First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, 35 East Dingxi Road, Lanzhou, Gansu, 730000, China
- First Department of Thoracic Surgery, Gansu Provincial Hospital, 204 Donggang West Road, Lanzhou, Gansu, 730000, China
| | - Dacheng Jin
- First Department of Thoracic Surgery, Gansu Provincial Hospital, 204 Donggang West Road, Lanzhou, Gansu, 730000, China
| | - Yunjiu Gou
- First Department of Thoracic Surgery, Gansu Provincial Hospital, 204 Donggang West Road, Lanzhou, Gansu, 730000, China.
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van der Weijde E, Kuijpers M, Bouma W, Mariani MA, Klinkenberg TJ. Staged single-port thoracoscopic R2 sympathicotomy as a reproducible, safe and effective treatment option for debilitating severe facial blushing. Interact Cardiovasc Thorac Surg 2022; 35:6761105. [DOI: 10.1093/icvts/ivac257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/19/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
OBJECTIVES
Our goal was to investigate the safety, feasibility, success rate, complication rate and side effects of staged single-port thoracoscopic R2 sympathicotomy in the treatment of severe facial blushing. Facial blushing is considered a benign condition; however, severe facial blushing can have a major impact on quality of life. When nonsurgical options such as medication and psychological treatments offer no or insufficient relief, surgical treatment with thoracoscopic sympathicotomy should be considered.
METHODS
All patients who underwent a staged thoracoscopic sympathicotomy at level R2 for severe facial blushing between January 2016 and September 2021 were included. Clinical and surgical data were prospectively collected and analysed.
RESULTS
A total of 16 patients with low operative risk (American Society of Anesthesiologists class 1) were treated. No major perioperative complications were encountered. One patient experienced postoperative unilateral Horner’s syndrome that resolved completely after 1 week. Two patients experienced compensatory hyperhidrosis. The success rate was 100%. One patient experienced a slight recurrence of blushing symptoms after 3 years that did not interfere with their quality of life. All patients were satisfied with the results and had no regrets of having undergone the procedure.
CONCLUSIONS
Staged single-port thoracoscopic R2 sympathicotomy is a reproducible, safe and highly effective surgical treatment option with low compensatory hyperhidrosis rates and the potential to significantly improve quality of life in carefully selected patients suffering from severe facial blushing. We would like to increase awareness among healthcare professionals for debilitating facial blushing and suggest timely referral for surgical treatment.
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Affiliation(s)
- Emma van der Weijde
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| | - Michiel Kuijpers
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| | - Wobbe Bouma
- Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| | - Massimo A Mariani
- Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| | - Theo J Klinkenberg
- Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
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Selective T 3-T 4 sympathicotomy versus gray ramicotomy on outcome and quality of life in hyperhidrosis patients: a randomized clinical trial. Sci Rep 2021; 11:17628. [PMID: 34475473 PMCID: PMC8413289 DOI: 10.1038/s41598-021-96972-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 08/11/2021] [Indexed: 11/21/2022] Open
Abstract
Compensatory hyperhidrosis is the leading cause of patients' dissatisfaction after thoracic sympathicotomy. The study aimed to reduce compensatory hyperhidrosis to increase patients’ satisfaction. A prospective randomized study on palmar hyperhidrosis, May 2016–September 2019. Twenty-one patients T3–T4 sympathicotomy and 21 T3–T4 gray ramicotomy. Data prospectively collected. Analysis at study's end. Focus on the sweating, temperature, quality of life baseline and postoperatively, compensatory hyperhidrosis, hand dryness, patients' satisfaction, and if they would undergo the procedure again and recommend it. No baseline differences between groups. Hyperhidrosis was controlled postoperatively in all patients. No mortality, serious complications, or recurrences. Sympathicotomy worse postoperative quality of life (49.05 (SD: 15.66, IR: 35.50–63.00) versus ramicotomy 24.30 (SD: 6.02, IR: 19.75–27.25). After ramicotomy, some residual sweating on the face, hands, and axillae. Compensatory sweating worse with sympathicotomy. Satisfaction higher with ramicotomy. Better results with ramicotomy than sympathicotomy regarding hand dryness, how many times a day the patients had to shower or change clothes, intention to undergo the procedure again or recommend it to somebody else, and how bothersome compensatory hyperhidrosis was. T3–T4 gray ramicotomy had better results than T3–T4 sympathicotomy, with less compensatory sweating and higher patients' satisfaction.
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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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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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Xie H, Lu T, Zhu Y, Zhu D, Wei T, Yuan G, Yang Y, Liu X. A retrospective cohort study of T3 versus T4 thoracoscopic sympathectomy for primary palmar hyperhidrosis and primary palmar hyperhidrosis with axillary and plantar sweating. Wideochir Inne Tech Maloinwazyjne 2020; 15:488-495. [PMID: 32904609 PMCID: PMC7457198 DOI: 10.5114/wiitm.2019.89656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/15/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Thoracoscopic sympathectomy (TS) has been proven to be a safe and effective treatment for primary palmar hyperhidrosis (PH). However, the complications include compensatory hyperhidrosis (CH), and over-dry hands may occur in some patients after TS. AIM To compare the therapeutic effect of T3 and T4 TS on primary PH and primary PH with axillary and plantar sweating. MATERIAL AND METHODS We retrospectively analyzed 100 patients with PH who had undergone T3 (group A, n = 49) or T4 (group B, n = 51) TS in our department, with at least 1 year of postoperative follow-up. RESULTS At discharge, no major complications or deaths occurred in either group. The condition of sweaty hands was fully improved in 44 of 49 patients in group A and all patients in group B, with a significant difference (p = 0.031). After 12 months of follow-up, 18 (36.7%) patients in group A and 4 (7.8%) patients in group B developed CH, 16 (48.5%) patients in group A and 24 (77.4%) patients in group B had improved axillary sweating, with a significant difference (p < 0.05). The satisfaction rate of group B was significantly higher than that of group A (p < 0.01). CONCLUSIONS Both T3 and T4 TS were safe and effective treatments for PH patients, but the incidence of CH in T4 TS was lower than that in T3 TS. T3 TS may be more suitable for patients with severe PH, while T4 TS had a better therapeutic effect on PH patients with axillary sweating.
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Affiliation(s)
- Hongya Xie
- Department of Thoracic Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou City, Jiangsu Province, China
| | - Tao Lu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yimeng Zhu
- Department of Thoracic Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou City, Jiangsu Province, China
| | - Donglin Zhu
- Department of Thoracic Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou City, Jiangsu Province, China
| | - Tengteng Wei
- Department of Thoracic Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou City, Jiangsu Province, China
| | - Guangda Yuan
- Department of Thoracic Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou City, Jiangsu Province, China
| | - Yong Yang
- Department of Thoracic Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou City, Jiangsu Province, China
| | - Xiaoqiang Liu
- Department of Thoracic Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou City, Jiangsu Province, China
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Lin JB, Chen JF, Lai FC, Li X, Xie JB, Tu YR, Kang MQ. Involvement of activin a receptor type 1 (ACVR1) in the pathogenesis of primary focal hyperhidrosis. Biochem Biophys Res Commun 2020; 528:299-304. [PMID: 32473755 DOI: 10.1016/j.bbrc.2020.05.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/07/2020] [Indexed: 12/29/2022]
Abstract
The pathogenesis of primary focal hyperhidrosis (PFH) is still not clear. PFH is thought to be a genetic disease. Whether activin A receptor type 1 (ACVR1) is involved in the pathogenesis of PFH is unknown. In this study, the expression of ACVR1 in sweat glands of patients with PAH was detected by western blot and immunofluorescence. The primary sweat gland cells obtained from primary axillary hyperhidrosis (PAH) patients were transfected with acvr1 vector. Cell proliferation, apoptosis and cell cycling of gland cells were measured after transfection with acvr1 vector. The mRNA and protein expression of aquaporin 5 (AQP5) and Na:K:2Cl Cotransporter 1 (NKCC1/SLC12A2) were detected. Our data showed that ACVR1 expression in axillary sweat gland tissue of PAH patients was significantly higher than that of normal control group. The function of ACVR1 was further investigated in the gland cells obtained from PAH patients. Compared with NC group, ACVR1 overexpression significantly promoted the proliferation of sweat gland cells and inhibited the apoptosis of sweat gland cells. Meanwhile, ACVR1 overexpression significantly reduced the percentage of cells in G0/G1 and G2/M phases, and increased the percentage of cells in S phase. In addition, ACVR1 overexpression significantly promoted the expression of AQP5 and NKCC1 at both mRNA and protein levels. Together, ACVR1 expression is related to PFH and ACVR1 overexpression can promote the proliferation of sweat gland cells and inhibit apoptosis by promoting the expression of AQP5 and NKCC1.
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Affiliation(s)
- Jian-Bo Lin
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Gulou District, Fuzhou, People's Republic of China; Department of Thoracic Surgery, First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou, People's Republic of China
| | - Jian-Feng Chen
- Department of Thoracic Surgery, First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou, People's Republic of China
| | - Fan-Cai Lai
- Department of Thoracic Surgery, First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou, People's Republic of China
| | - Xu Li
- Department of Thoracic Surgery, First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou, People's Republic of China
| | - Jin-Bao Xie
- Department of Thoracic Surgery, First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou, People's Republic of China
| | - Yuan-Rong Tu
- Department of Thoracic Surgery, First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou, People's Republic of China
| | - Ming-Qiang Kang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Gulou District, Fuzhou, People's Republic of China.
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Wei Y, Xu ZQD, Li H. Quality of life after thoracic sympathectomy for palmar hyperhidrosis: a meta-analysis. Gen Thorac Cardiovasc Surg 2020; 68:746-753. [PMID: 32390086 DOI: 10.1007/s11748-020-01376-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Palmar hyperhidrosis affects 0.6-10% of the general population, having an important impact in patients' quality of life. The definitive treatment for palmar hyperhidrosis is thoracic sympathectomy. The purpose of this study is to evaluate the quality of life after thoracic sympathectomy for palmar hyperhidrosis. METHODS The interest studies were searched in six comprehensive databases. The quality of the studies was assessed using the risk of bias tool recommended by the Cochrane system evaluation manual. Meta-analysis was performed with RevMan version 5.3. The outcome of interest was quality of life. The subgroup analysis and sensitive analysis were performed. RESULTS Nine trials, including 895 patients, with accessible data comparing preoperative quality of life score with postoperative quality-of-life score were used for data analysis. Compared with preoperative quality-of-life score, application of thoracic sympathectomy improved the postoperative quality of life of palmar hyperhidrosis patients (MD = 57.81, 95% CI 53.33-62.30). Subgroup analysis of the different thoracic sympathectomy segment showed that there was no significant difference in the results obtained when operated with single segment or multiple segments (single segment: MD = 61.16, 95% CI [56.10, 66.22], multiple segments: MD = 52.14, 95% CI [48.39, 55.88]). CONCLUSION The meta-analysis provided evidence of the improved quality of life after thoracic sympathectomy for palmar hyperhidrosis.
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Affiliation(s)
- Yunwei Wei
- Capital Medical University, Beijing, China.,Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhi-Qing David Xu
- Department of Neurobiology, School of Basic Medical Science, Capital Medical University, Beijing, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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Nicolini EM, Costa VDO, Montessi J, Rodrigues GDA, Cangussu VV, Reis AFM, Marques Filho FV. Video-assisted thoracic sympathectomy: literature review. Rev Col Bras Cir 2019; 46:e2157. [PMID: 31141034 DOI: 10.1590/0100-6991e-20192157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/12/2019] [Indexed: 11/22/2022] Open
Abstract
Thoracic sympathectomy has been effective in relieving hyperhidrosis in several patients, with quality of life improvement. The knowledge of the clinical picture of each patient, as well as the possible postoperative complications, are fundamental to obtain good results. Thus, we performed a review of articles from the PubMed database published between 2005 and 2019 that presented, as the main topic, thoracoscopy sympathectomy for the treatment of hyperhidrosis, with the objective of evaluating the current state of art referring to postoperative quality of life, surgical time and its complications. From this analysis, we verified the importance of the level of sympathetic ganglion chain section in relation to results. The complication, although occurring, did not reduced the postoperative level of satisfaction or patients' quality of life.
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Affiliation(s)
- Eveline Montessi Nicolini
- Hospital e Maternidade Therezinha de Jesus, Serviço de Cirurgia Torácica, Juiz de Fora, MG, Brasil.,Hospital Monte Sinai, Serviço de Cirurgia Torácica, Juiz de Fora, MG, Brasil
| | - Víctor de Oliveira Costa
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Curso de Medicina, Juiz de Fora, MG, Brasil
| | - Jorge Montessi
- Hospital e Maternidade Therezinha de Jesus, Serviço de Cirurgia Torácica, Juiz de Fora, MG, Brasil.,Hospital Monte Sinai, Serviço de Cirurgia Torácica, Juiz de Fora, MG, Brasil
| | - Guilherme de Abreu Rodrigues
- Hospital e Maternidade Therezinha de Jesus, Serviço de Cirurgia Torácica, Juiz de Fora, MG, Brasil.,Hospital Monte Sinai, Serviço de Cirurgia Torácica, Juiz de Fora, MG, Brasil
| | | | - Ana Flávia Miranda Reis
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Curso de Medicina, Juiz de Fora, MG, Brasil
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Musa AF, Gandhi VP, Dillon J, Nordin RB. A retrospective review on minimally invasive technique via endoscopic thoracic sympathectomy (ETS) in the treatment of severe primary hyperhidrosis: Experiences from the National Heart Institute, Malaysia. F1000Res 2018; 7:670. [PMID: 32724556 PMCID: PMC7338916 DOI: 10.12688/f1000research.14777.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Hyperhidrosis is due to the hyperactive autonomic stimulation of the sweat glands in response to stress. Primary hyperhidrosis is a common yet psychologically disabling condition. This study will describe our experience in managing hyperhidrosis via endoscopic thoracic sympathectomy (ETS). Methods: The information was obtained from the patient records from 1
st January 2011 until 31
st December 2016. Pertinent information was extracted and keyed into a study proforma. Results: 150 patients were operated on but only 118 patients were included in this study. The mean age was 22.9±7.3 years. The majority (54.2%) had palmar-plantar hyperhidrosis and 39.8% had associated axillary hyperhidrosis. Excision of the sympathetic nerve chain and ganglia were the main surgical technique with the majority (55.9%) at T2-T3 level. Mean ETS procedure time was 46.6±14.29 minutes with no conversion. Surgical complications were minimal and no Horner’s Syndrome reported. Mean hospital stay was 3.5±1.05 days. The majority of patients (67.8%) had only one follow-up and only half of the study sample (58.5%) complained mild to moderate degree of compensatory sweating, even though the long-term resolution is yet to be determined by another study. Following ETS, 98.3% of patients had instant relief and resolved their palmar hyperhidrosis. Predictors of CS were sympathectomy level and follow-up. The odds of reporting CS was 2.87 times in patients undergoing ETS at the T2-T3 level compared to those undergoing ETS at the T2-T4 level. The odds of reporting CS was 13.56 times in patients having more than one follow-up compared to those having only one follow-up. Conclusion: We conclude that ETS is a safe, effective and aesthetically remarkable procedure for the treatment of primary hyperhidrosis with only half of the patients developing mild to moderate degree of CS. Significant predictors of CS were sympathectomy level during ETS and frequency of follow-up after ETS.
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Affiliation(s)
- Ahmad Farouk Musa
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Vignaa Prashanth Gandhi
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Jeswant Dillon
- Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia
| | - Rusli Bin Nordin
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
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Sang HW, Li GL, Xiong P, Zhu MC, Zhu M. Optimal targeting of sympathetic chain levels for treatment of palmar hyperhidrosis: an updated systematic review. Surg Endosc 2017; 31:4357-4369. [PMID: 28389800 DOI: 10.1007/s00464-017-5508-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/08/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Palmar hyperhidrosis involves excessive sweating of the palms, with no known etiology. Endoscopic thoracic sympathectomy (ETS) is a safe and effective treatment for palmar hyperhidrosis, but compensatory hyperhidrosis is a common complication after ETS, leading to reduced patient satisfaction and postoperative quality of life. However, the appropriate level of the sympathetic chain to target with ETS to achieve maximum efficacy and reduce the risk of compensatory hyperhidrosis (CH) is controversial. In this systemic review, we investigated the appropriate level of sympathectomy for palmar hyperhidrosis. METHODS PRISMA guidelines were implemented to complete a systematic review. We performed a computerized systematic literature search using PubMed and EMBASE from January 1990 to July 2016. We chose the Cochrane Collaboration's tool and the methodological index for non-randomized studies tool for examining study bias. RESULTS A total of 4075 citations were identified, of which 91 were eligible for inclusion, including 68 observational studies and 23 comparative trials. In observational studies, sympathectomies showed similar efficacies for curing PH at different levels. However, T2-free groups (i.e., at levels T3, T4, or T3-T4 combined) could render a lower risk of Horner's syndrome (0 vs. 1.21 ± 0.49%, p = 0.036) and CH (28.75 ± 7.25 vs. 57.46 ± 3.86, p = 0.002) compared with T2 involved. In comparative trials, there were 12 studies describing the comparison between T2-free ETS and T2 involved, and 9 of 12 (75%) showed T2-free ETS could reduce the incidence of CH. Overall, lowering the level and limiting the extent of sympathectomy could reduce the incidence of complications. CONCLUSIONS Cumulative data from more than 13,000 patients suggest that ETS is a safe, effective, and reproducible procedure with a high degree of patient satisfaction. Currently available evidence suggests that T2-free ETS may reduce the incidence of compensatory hyperhidrosis without compromising success rates and safety.
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Affiliation(s)
- Hai-Wei Sang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, Hubei, China.,Department of Thoracic Surgery, First Affiliated Hospital of Bengbu Medical College, 287 Chang Huai Road, Bengbu, 233004, Anhui, China
| | - Guo-Liang Li
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, Hubei, China
| | - Peng Xiong
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, Hubei, China
| | - Ming-Chuang Zhu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, Hubei, China
| | - Min Zhu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, Hubei, China.
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Guo JG, Fei Y, Huang B, Yao M. CT-guided thoracic sympathetic blockade for palmar hyperhidrosis: Immediate results and postoperative quality of life. J Clin Neurosci 2016; 34:89-93. [DOI: 10.1016/j.jocn.2016.05.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 05/05/2016] [Accepted: 05/09/2016] [Indexed: 02/07/2023]
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Sternbach JM, DeCamp MM. Targeting the Sympathetic Chain for Primary Hyperhidrosis. Thorac Surg Clin 2016; 26:407-420. [DOI: 10.1016/j.thorsurg.2016.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Bagheri R, Sharifian Attar A, Haghi SZ, Salehi M, Moradpoor R. Thoracoscopic sympathicotomy in the treatment of palmar hyperhidrosis. Asian Cardiovasc Thorac Ann 2016; 24:687-91. [DOI: 10.1177/0218492316657729] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Primary hyperhidrosis interferes with social activities and requires an effective and safe treatment. We aimed to compare the therapeutic outcomes of unilateral single-port sympathicotomy and open surgery. Methods Forty patients with primary palmar hyperhidrosis underwent sympathicotomy; 20 had open surgery, and 20 had video-assisted thoracic surgery. Complete resection of the T1 to T4 ganglia was performed by open surgery, and cutting and cauterization of the sympathetic chain between the T2 and T3 ganglia in the dominant hand was undertaken using video-assisted thoracic surgery. The patients were followed up at 1, 3, 6, and 12 months after surgery. Results The mean operative times were 39.6 ± 1.46 and 79.8 ± 1.53 min in the video-assisted thoracic surgery and open surgery group, respectively. The mean hospitalization was 2.2 ± 0.41 days after video-assisted thoracic surgery and 3.3 ± 0.47 days after open surgery. Complications included delayed hemothorax, compensatory hyperhidrosis, and wound infection. The mean blood loss during surgery and time to return to work were significantly less in the video-assisted thoracic surgery group. Excessive sweating was completely alleviated in the dominant hand in all patients, and in the opposite hand in 60% and 65% of the video-assisted thoracic surgery and open surgery group, respectively. Conclusion Single-port sympathicotomy between the T2 and T3 ganglia ipsilateral to the dominant hand is a safe, minimally invasive, and effective treatment for primary palmar hyperhidrosis. Alleviation of excessive sweating in the opposite hand can also be achieved in a large proportion of these patients.
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Affiliation(s)
- Reza Bagheri
- Cardiothoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Sharifian Attar
- Cardiothoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Ziaollah Haghi
- Cardiothoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Salehi
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Rosita Moradpoor
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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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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Up-to-date Treatments of Primary Hyperhidrosis with Focus on Sympathectomy and Sympathicotomy; A Narrative Review. HOSPITAL PRACTICES AND RESEARCH 2016. [DOI: 10.20286/hpr-01013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Karamustafaoglu YA, Kuzucuoglu M, Yanik F, Sagiroglu G, Yoruk Y. 3-year follow-up after uniportal thoracoscopic sympathicotomy for hyperhidrosis: undesirable side effects. J Laparoendosc Adv Surg Tech A 2015; 24:782-5. [PMID: 25376004 DOI: 10.1089/lap.2014.0380] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Endoscopic thoracic sympathectomy or sympathicotomy, for the treatment of palmar, axillary, and plantar hyperhidrosis, is generally performed at one or two levels, between T2 and T5. Compensatory sweating (CS) is a severe and undesirable side effect of this procedure. Here, we describe the success of treatment and degree of postoperative CS in sympathicotomy patients. SUBJECTS AND METHODS This study included 80 patients treated by uniportal (5-mm) thoracoscopic sympathicotomy (electrocautery) for primary hyperhidrosis over a 6-year period (2007-2013). Sympathicotomy was performed bilaterally at T2 for blushing (n=2), T2-T3 for palmar-only hyperhidrosis (n=34), T2-T4 for palmar and axillary hyperhidrosis (n=39), and T3-T4 for axillary-only hyperhidrosis (n=5). Outcome was assessed 2 weeks postsurgery at the clinic and annually thereafter by telephone questionnaire. Mean follow-up time was 35.2±23.3 months. Questionnaires assessed patients' degree of sweating, postoperative CS, overall satisfaction, and complications. RESULTS Seventy-one patients (88.7%) were very satisfied, whereas only 9 (11.3%) were dissatisfied with the procedure. Complication incidence was 7.5%, and CS occurred in 77.5% of patients. Therapeutic success rate was 97.5%; complete relief of hyperhidrosis was achieved in 72 (90%) patients, whereas 8 (10%) experienced recurrence. CONCLUSIONS CS is a frequent side effect of thoracoscopic sympathicotomy. We recommend all patients undergoing this procedure should be warned of the potential risk of developing severe CS.
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Paliogiannis P, Marrosu A, Attene F, Trignano M, Scognamillo F. An unusual case of excessive sweating affecting the right upper limb after bilateral endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: recurrence or compensatory hyperhidrosis? Eur Surg 2014. [DOI: 10.1007/s10353-014-0275-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Bell D, Jedynak J, Bell R. Predictors of outcome following endoscopic thoracic sympathectomy. ANZ J Surg 2013; 84:68-72. [PMID: 23432865 DOI: 10.1111/ans.12098] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Endoscopic thoracic sympathectomy (ETS) provides definitive management for primary focal hyperhidrosis and facial blushing. These conditions are debilitating and not uncommon, but many clinicians avoid ETS due to the risk of complications, particularly compensatory sweating (CS). This retrospective cohort study aimed to evaluate the degree of symptom resolution, patient satisfaction and adverse reactions after ETS and to identify subgroups of patients more likely to achieve a satisfactory outcome. METHODS From 2004 to 2010, 210 patients underwent ETS performed by a single surgeon. These patients responded to a questionnaire regarding levels of satisfaction, symptom resolution and complications encountered, particularly CS. RESULTS Palmar hyperhidrosis (97%) and scalp/facial hyperhidrosis (93%) demonstrated greater degrees of symptom resolution than axillary hyperhidrosis (71%) and facial blushing (71%) (P < 0.001). Rates of severe CS were lowest in patients with palmar hyperhidrosis (8%) and highest in patients with axillary (26%) and scalp/facial (44.5%) hyperhidrosis (P = 0.0003). The probability of experiencing no CS was highest at young ages and decreased with age (P = 0.0006). Satisfaction rates also fell as age increased (P = 0.004). Satisfaction rates were highest in patients with palmar (90%) and lowest in patients with scalp/facial (52%) hyperhidrosis (P < 0.02). DISCUSSION Patient satisfaction following ETS is highest among younger patients and those undergoing the procedure for palmar hyperhidrosis. Dissatisfaction arises from failure to achieve the desired aim as well as the development of severe CS, which is more common in older patients and those undergoing ETS for axillary and scalp/facial hyperhidrosis.
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Affiliation(s)
- David Bell
- Department of Vascular Surgery, Monash Medical Centre, Clayton, Victoria, Australia
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Mohebbi HA, Mehrvarz S, Manoochehry S. Thoracoscopic Sympathicotomy vs Sympathectomy in Primary Hyperhidrosis. Trauma Mon 2012; 17:291-5. [PMID: 24350109 PMCID: PMC3860636 DOI: 10.5812/traumamon.6335] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 06/25/2012] [Accepted: 06/26/2012] [Indexed: 11/17/2022] Open
Abstract
Background Primary 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. Objectives To evaluate and compare the early and late satisfaction, outcomes and complications of thoracoscopic sympathectomy and sympathicotomy in the treatment of primary hyperhidrosis. Materials and Methods From 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. Results The 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. Conclusions Because 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.
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Affiliation(s)
- Hassan Ali Mohebbi
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Department of General Surgery, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Shaban Mehrvarz
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Shahram Manoochehry
- Department of General Surgery, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Shahram Manoochehry, General Surgery Department, Baqiyatallah University of Medical Science, Tehran, IR Iran. Tel/Fax: +98-2181263550,
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Ramos R, Ureña A, Rivas F, Macia I, Rosado G, Pequeño S, Masuet C, Badia M, Miguel M, Delgado MA, Escobar I, Moya J. Impact of T3 thoracoscopic sympathectomy on pupillary function: a cause of partial Horner’s syndrome? Surg Endosc 2011; 26:1146-52. [DOI: 10.1007/s00464-011-2022-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Accepted: 10/17/2011] [Indexed: 10/16/2022]
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The Use of Oxybutynin for Treating Axillary Hyperhidrosis. Ann Vasc Surg 2011; 25:1057-62. [DOI: 10.1016/j.avsg.2011.06.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 05/24/2011] [Accepted: 06/03/2011] [Indexed: 11/17/2022]
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Currie AC, Evans JR, Thomas PRS. An analysis of the natural course of compensatory sweating following thoracoscopic sympathectomy. Int J Surg 2011; 9:437-9. [PMID: 21539945 DOI: 10.1016/j.ijsu.2011.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 04/12/2011] [Accepted: 04/13/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND To evaluate the long-term results of thoracoscopic sympathectomy in the treatment of hyperhydrosis. METHODS Theatre log books were used to identify all patients who underwent thoracoscopic sympathectomy between 2000 and 2006. Details of pre-operative symptoms, surgical procedure and post-operative complications were collected from the patient notes. Each patient was sent a questionnaire regarding success of the procedure, compensatory sweating and overall satisfaction. RESULTS 46 hyperhydrosis patients (34 females) age range 14-57 years. 20 patients suffered with hyperhydrosis in a combination of areas, 14 in the axillae alone, 9 palms alone and with 2 facial symptoms. There were 2 early post-operative complications, 1 haemothorax which required a chest drain and a chest infection. 3 patients required redo procedures. Of follow-up of 42 months (range 6-84), 32 (69·5%) patients reported complete dryness or a significant improvement in symptoms and 15 a substantial improvement in quality of life. However 43 patients (93%) suffered with compensatory sweating, of these 27 had to change clothes more than once daily. Compensatory sweating was graded as severe in 18 and incapacitating in 2. Of note only 5 patients noticed an improvement in the compensatory sweating over time. Only 26 (56%) would recommend thoracoscopic sympathectomy to others with hyperhydrosis. CONCLUSION Thoracoscopic sympathectomy is effective in the treatment of hyperhydrosis. However compensatory sweating seems unavoidable and infrequently improves with time. Patients need to be carefully counselled before committing to surgery.
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Affiliation(s)
- A C Currie
- Department of Surgery, Division of Surgery and Cancer, Imperial College, London W2 1NY, United Kingdom
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