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Masarwa H, Salama N, Turk A, Abuawad M, Hawari A, Ziyadeh J, Al Zabadi H. Incidence and Severity of Compensatory Hyperhidrosis Following Bilateral Sympathectomy. Ann Vasc Surg 2024; 108:317-324. [PMID: 39002894 DOI: 10.1016/j.avsg.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 04/28/2024] [Accepted: 05/09/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Primary hyperhidrosis is a condition caused by an excessive stimulation of sweat glands, leading to a decline in both quality of life and social wellbeing. Thoracic sympathectomy surgery provides a relief of the initial symptoms but poses a risk for developing compensatory hyperhidrosis (CH) in various degrees. OBJECTIVE The aim of this study was to assess the occurrence and characteristics of CH post-thoracic sympathectomy. METHODS A retrospective cohort study of patients who underwent video-assisted thoracic sympathectomy surgery at level T2-T3 between 2016 and 2022 was conducted. Patients' data were retrieved from medical records and through a telephone interview. RESULTS A total of 50 patients (32 males and 18 females) were operated on with a mean ± standard deviation (SD) age of 25.9 ± 7.4 years at the time of surgery for palmoplantar hyperhidrosis. Initial symptoms started in childhood at a mean ± SD age of 11.4 ± 3.3 years. Postoperatively, 39 patients (78%) developed CH, more prevalent in males (64.1%) compared to females (35.8%). This CH mainly affected the back and abdomen (100%), followed by the groin and thighs (28.2%), and, to a lesser extent, the craniofacial area (15.3%). Onset of symptoms occurred within 1 week after surgery in 71.7% of cases, with 71.7% reporting mild to moderate symptoms. CH was significantly associated with higher age at the time of surgery, smoking status, and a longer time lapse in the surgery operation (P value < 0.05). CONCLUSIONS Thoracic sympathectomy is an effective procedure with a high success rate. Despite a relatively higher occurrence of CH, most patients experience milder symptoms and express satisfaction, noting that their expectations were met following the surgery.
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Affiliation(s)
- Hanaa Masarwa
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Nahar Salama
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Abdullah Turk
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mohammad Abuawad
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
| | - Abdallah Hawari
- General and minimally invasive surgeon, Hepato-biliary and pancreatic surgeon, An-Najah National University, Nablus, Palestine
| | - Jawad Ziyadeh
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; Department of Neurosurgery, An-Najah National University Hospital, Nablus, Palestine
| | - Hamzeh Al Zabadi
- Public Health Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Zhong Y, Zhu Y, Li J, Yang X, Feng Z, Liu H, Liang Z, Lin B, Liu Z, Wang X, Luo W, Zhu J, Li B, Lai S, Jiang W, Wu J, Li D, Zhang L, Huang B, Tang J. Efficacy and safety of radiofrequency ablation versus surgical sympathectomy in palmar hyperhidrosis. Sci Rep 2024; 14:7620. [PMID: 38556580 PMCID: PMC10982298 DOI: 10.1038/s41598-024-57834-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/22/2024] [Indexed: 04/02/2024] Open
Abstract
Radiofrequency ablation (RFA) comparative efficacy of treatments using video-assisted thoracoscopic sympathectomy (VATS) in the long term remains uncertain in patients with palmar hyperhidrosis (PHH). This study aimed to compare the efficacy and safety of RFA and VATS in patients with PHH. We recruited patients aged ≥ 14 years with diagnosed PHH from 14 centres in China. The treatment options of RFA or VATS were assigned to two cohort in patients with PHH. The primary outcome was the efficacy at 1-year. A total of 807 patients were enrolled. After propensity score matching, the rate of complete remission was lower in RFA group than VATS group (95% CI 0.21-0.57; p < 0.001). However, the rates of palmar dryness (95% CI 0.38-0.92; p = 0.020), postoperative pain (95% CI 0.13-0.33; p < 0.001), and surgery-related complications (95% CI 0.19-0.85; p = 0.020) were lower in RFA group than in VATS group, but skin temperature rise was more common in RFA group (95% CI 1.84-3.58; p < 0.001). RFA had a lower success rate than VATS for the complete remission of PHH. However, the symptom burden and cost are lower in patients undergoing RFA compared to those undergoing VATS.Trial Registration: ChiCTR2000039576, URL: http://www.chictr.org.cn/index.aspx .
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Affiliation(s)
- Yiyue Zhong
- Department of Anaesthesiology and Pain Medicine, Affiliated Hospital of Guangdong Medical University, No. 57 People Avenue South, Zhanjiang, 524001, Guangdong, China
| | - Yanwen Zhu
- Department of Anaesthesiology and Pain Medicine, Affiliated Hospital of Guangdong Medical University, No. 57 People Avenue South, Zhanjiang, 524001, Guangdong, China
| | - Jiayan Li
- Department of Thoracic Cardiovascular Surgery, Gaozhou People's Hospital, No. 89 Xiguan Road, Gaozhou, 525200, Guangdong, China
| | - Xiaowei Yang
- Department of Thoracic Cardiovascular Surgery, The First Hospital of Wuhan, No. 215 Zhongshan Road, Qiaokou District, Wuhan, 430070, China
| | - Zhiying Feng
- Department of Pain Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, 310003, China
| | - Haipeng Liu
- Department of Pain Medicine, Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou, 730000, Gansu, China
| | - Zhu Liang
- Department of Thoracic Cardiovascular Surgery, Affiliated Hospital of Guangdong Medical University, No. 57 People Avenue South, Zhanjiang, 524001, Guangdong, China
| | - Baoquan Lin
- Department of Thoracic Cardiovascular Surgery, The 900Th Hospital of Joint Logistic Support Force, No. 156 West Second Ring North Road, Fuzhou, 350000, Fujian, China
| | - Zhifeng Liu
- Department of Critical Care Medicine, General Hospital of Southern Theatre Command of PLA, Guangzhou, 510010, China
| | - Xin Wang
- Department of Pain Medicine, The Third People's Hospital of Huizhou, No. 1, Qiaodong Xuexiu Street, Huicheng District, Huizhou, 516000, Guangdong, China
| | - Weibin Luo
- Department of Thoracic Cardiovascular Surgery, The Second People's Hospital of Shenzhen, No. 3002 Sungang West Road, Futian District, Shenzhen, 518000, Guangdong, China
| | - Jian Zhu
- Department of Thoracic Cardiovascular Surgery, General Hospital of Central Theater Command of the People's Liberation Army, 627#, Wuluo Road, Wuchang District, Wuhan, 430070, Hubei, China
| | - Bin Li
- Department of Thoracic Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 310000, China
| | - Shangdao Lai
- Department of Pain Medicine, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-Sen University, No. 63 Huangtang Road, Meijiang District, Meizhou, 514031, China
| | - Weize Jiang
- Department of Pain Medicine, China Railway Fuyang Central Hospital, No. 161 Xingfu Road, Yingdong District, Fuyang, 236000, Anhui, China
| | - Jiayuan Wu
- Department of Clinical Research, Affiliated Hospital of Guangdong Medical University, No. 57, South of People Avenue, Zhanjiang, 524001, Guangdong, China
| | - Daheng Li
- Department of Anaesthesiology and Pain Medicine, Affiliated Hospital of Guangdong Medical University, No. 57 People Avenue South, Zhanjiang, 524001, Guangdong, China
| | - Liangqing Zhang
- Department of Anaesthesiology and Pain Medicine, Affiliated Hospital of Guangdong Medical University, No. 57 People Avenue South, Zhanjiang, 524001, Guangdong, China
| | - Bing Huang
- Department of Anaesthesiology and Pain Center, The Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Jing Tang
- Department of Anaesthesiology and Pain Medicine, Affiliated Hospital of Guangdong Medical University, No. 57 People Avenue South, Zhanjiang, 524001, Guangdong, China.
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Chen LWY, Chang TNJ, Lee CP, Sung CWH, Cheng C, Chang KH, Chao YK. Robotic sympathetic trunk reconstruction for compensatory sweating after thoracic sympathectomy. JTCVS Tech 2023; 21:251-258. [PMID: 37854845 PMCID: PMC10579868 DOI: 10.1016/j.xjtc.2023.05.022] [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: 03/13/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 10/20/2023] Open
Abstract
Objectives Endoscopic thoracic sympathectomy may be complicated by the onset of disabling compensatory sweating (CS). The objective of this case series is to report the 2-year outcomes after robotic sympathetic trunk reconstruction (STR) for the reversal of CS in patients who had undergone endoscopic thoracic sympathectomy. Methods We prospectively followed-up a total of 23 patients who had undergone robotic STR because of intolerable CS between October 2017 and January 2021. A visual analog scale ranging from 0 to 10 (with 10 indicating the highest degree) was used to assess the severity of CS at different anatomical locations, thermoregulatory alterations, and gustatory hyperhidrosis. Measurements were performed before STR and at 6-month and 2-year follow-up. Results The mean age of the study participants was 43.3 ± 7.8 years, and 20 (87%) were men. The reversal procedure was performed after a mean of 19.6 ± 7.8 years from endoscopic thoracic sympathectomy. In all patients, nerve defects were successfully bridged using sural nerves (mean length, 9.7 cm on the right and 9.8 cm on the left). No cases of Horner syndrome were noted. At 6 postoperative months, the severity of CS decreased significantly at all body surface areas. The observed improvements were effectively maintained at 24 post-STR months. There was no evidence of either recurrent hyperhidrosis at the primary site or transition of CS to other anatomical locations. Similar improvements were evident for thermoregulatory alterations and gustatory hyperhidrosis. Conclusions Robotic STR is safe and effective in reversing intolerable CS after endoscopic thoracic sympathectomy.
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Affiliation(s)
- Lisa Wen-Yu Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tommy Nai-Jen Chang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chin-Pang Lee
- Department of Psychiatry, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Cheyenne Wei-Hsuan Sung
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chuan Cheng
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Hsuan Chang
- Department of Neurology, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Carvalho C, Marinho AS, Sequeira JB, Banquart-Leitão J, Carvalho F. Primary focal hyperhidrosis in children: Are we improving their lives? Australas J Dermatol 2023; 64:e84-e86. [PMID: 36349454 DOI: 10.1111/ajd.13950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Catarina Carvalho
- Pediatric Surgery Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Sofia Marinho
- Pediatric Surgery Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Joana Barbosa Sequeira
- Pediatric Surgery Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - José Banquart-Leitão
- Pediatric Surgery Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Fátima Carvalho
- Pediatric Surgery Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Huang Y, Liu Y, Zou W, Mao N, Tang J, Jiang L, Zou G, Yang L, Yu B, Wei G. Impact of endoscopic thoracic R4 sympathicotomy combined with R3 ramicotomy for primary palmar hyperhidrosis. Front Surg 2023; 10:1144299. [PMID: 36911618 PMCID: PMC9998541 DOI: 10.3389/fsurg.2023.1144299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/06/2023] [Indexed: 03/14/2023] Open
Abstract
Background Endoscopic thoracoscopic sympathectomy (ETS) is the preferred method for treating primary palmar hyperhidrosis (PPH) that bears the risk of compensatory hyperhidrosis (CH) following surgery. The current study aims to evaluate the effectiveness and safety of an innovative surgical procedure of ETS. Methods A survey of the clinical data of 109 patients with PPH who underwent ETS in our department from May 2018 to August 2021 was retrospectively conducted. The patients were organized into two groups. Group A underwent R4 sympathicotomy combined with R3 ramicotomy. Group B underwent R3 sympathicotomy. Patients were followed up to evaluate the safety, effectiveness and the incidence of postoperative CH of the modified surgical approach. Results A total of 102 patients completed follow-up, and seven of the total enrolled patients were lost to follow-up, with a loss rate of 6% (7/109). Among these, Group A constitutes 54 cases, group B constitutes 48 cases, and the mean follow-up was 14 months (interquartile range 12-23 months). There was no statistically difference in surgical safety, postoperative efficacy, and postoperative quality of life (QoL) score between group A and group B (p > 0.05). The score of the psychological assessment was higher (p = 0.004) in group A (14.15 ± 2.06) compared to group B (13.30 ± 1.86). The incidence of CH in group A was lower than in group B (p = 0.019). Conclusion R4 sympathicotomy combined with R3 ramicotomy is safe and effective for PPH treatment, along with a reduced incidence of postoperative CH rate and improved postoperative psychological satisfaction.
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Affiliation(s)
- Yunhe Huang
- Department of Thoracic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yunkun Liu
- Department of Thoracic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Zou
- Department of Thoracic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Na Mao
- Department of Thoracic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jian Tang
- Department of Thoracic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lei Jiang
- Department of Thoracic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Guowen Zou
- Department of Thoracic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lun Yang
- Department of Thoracic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bentong Yu
- Department of Thoracic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Guangxia Wei
- Department of Thoracic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
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Wu Y, Zhou Z, Zhang W, Tian S, Li C, He F, Chen G. Percutaneous Radiofrequency Sympatholysis in the Treatment of Primary Palmar Hyperhidrosis: A Retrospective Case-Controlled Study of Rib-Based Anatomical Targeting. J Vasc Interv Radiol 2023; 34:108-115. [PMID: 36182001 DOI: 10.1016/j.jvir.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/10/2022] [Accepted: 09/19/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To compare the efficacy, adverse reactions, quality of life, and patient satisfaction of percutaneous radiofrequency (RF) thoracic sympatholysis at different rib-based anatomic targets for primary palmar hyperhidrosis (PPHH). MATERIALS AND METHODS Patients with PPHH were divided according to the target, namely, the upper edge (Group U) and lateral border (Group L) of the fourth rib; there were 30 patients (mean age, 24.9 years; women, 31, 51.7%) and 60 cases in each group. The Hyperhidrosis Disease Severity Scale (HDSS) and Dermatology Life Quality Index (DLQI) were assessed. RESULTS From before RF sympatholysis to 12 months after, the proportion of patients with HDSS Grades III and IV (100%-26.7%) and the DLQI (19.78 ± 5.08 to 4.98 ± 4.18) decreased significantly (P < .001). At 3, 6, and 12 months after RF, the HDSS grades were better in Group L than in Group U (P = .005, .002, and .004). At 6 and 12 months after RF, the DLQI in Group L was lower than that in Group U (P = .012 and .016), and at 1, 6, and 12 months after RF, patient satisfaction was higher than that in Group U (P = .025, .014, and .009). Adverse events were mild; 8 patients (13.3%) demonstrated compensatory hyperhidrosis at 12 months after RF, and there was no difference between the 2 groups (P = .448); neuralgia and pneumothorax also did not differ (P = .522 and .643). CONCLUSIONS RF sympatholysis targeting the lateral border of the fourth rib had higher efficacy, better quality of life, and higher patient satisfaction.
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Affiliation(s)
- Yue Wu
- Department of Anesthesia and Pain Management, Sir Run Run Shaw Hospital, School of Medicine, Zhejang University, Hangzhou, Zhejiang, People's Republic of China
| | - ZhenFeng Zhou
- Department of Anesthesia and Pain Management, The Affiliated Women's Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, People's Republic of China
| | - Weibo Zhang
- Department of Anesthesia and Pain Management, Sir Run Run Shaw Hospital, School of Medicine, Zhejang University, Hangzhou, Zhejiang, People's Republic of China
| | - Suming Tian
- Department of Anesthesia and Pain Management, Sir Run Run Shaw Hospital, School of Medicine, Zhejang University, Hangzhou, Zhejiang, People's Republic of China
| | - Chunye Li
- Department of Pain Management, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, People's Republic of China
| | - Feifang He
- Department of Anesthesia and Pain Management, Sir Run Run Shaw Hospital, School of Medicine, Zhejang University, Hangzhou, Zhejiang, People's Republic of China
| | - Gang Chen
- Department of Anesthesia and Pain Management, Sir Run Run Shaw Hospital, School of Medicine, Zhejang University, Hangzhou, Zhejiang, People's Republic of China.
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Computed Tomography-Guided Percutaneous T4 Thoracic Sympathetic Radiofrequency Thermocoagulation for Primary Palmar Hyperhidrosis: A Retrospective Observational Trial. Cardiovasc Intervent Radiol 2023; 46:80-88. [PMID: 36316494 DOI: 10.1007/s00270-022-03305-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 10/16/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE To evaluate the efficacy, safety, and patient satisfaction of computed tomography (CT)-guided percutaneous T4 thoracic sympathetic radiofrequency thermocoagulation (RFT) for the treatment of primary palmar hyperhidrosis (PPHH). MATERIALS AND METHODS A total of 158 patients who underwent bilateral thoracic sympathetic RFT at the T4 level were analysed. Hyperhidrosis Severity Scale (HDSS), Dermatologic Quality of Life Index (DLQI), patient satisfaction, and adverse events were evaluated within 12 months after RFT. RESULTS The mean age of the patients was 25.27 years, and 95 (60.1%) were females. The technical success, defined as planned needle placement and completion of RFT, was 99.4%. After the procedure, 243 hands (77.4%) were completely dry; and 58 hands (18.4%) were partially dry. From before RFT to 12 months after RFT, the proportion of hands with the HDSS grades 3 and 4 from 100% decreased to 31.9%; and that with the DLQI scores D and E from 100% decreased to 4.0% (P < .001). The clinical success rate was 76.6%, and the patient satisfaction rate was 80.8% at 12 months after RFT. During the procedures, there was unilateral local bleeding in two patients (0.6%) and bradycardia in five patients (3.2%); after the procedures, unilateral pneumothorax occurred in 15 patients (4.7%) and closed thoracic drainage was performed in two patients (0.6%); thoracic neuralgia occurred in 24 patients (15.2%). The incidence of compensatory hyperhidrosis (CH) 12 months after RFT was 15.2%. CONCLUSIONS CT-guided percutaneous T4 thoracic sympathetic RFT is safe, effective, and minimally invasive for the treatment of PPHH. LEVEL OF EVIDENCE Level 2 observational study with dramatic effect.
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ASLANER O. Clinical Outcomes of Uniportal Versus Multiportal Endoscopic Thoracic Sympathectomy in Patients With Severe Palmar and Axillary Hyperhidrosis. ACTA MEDICA ALANYA 2022. [DOI: 10.30565/medalanya.1106046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: Palmar and axillary hyperhidrosis is caused by overstimulation of the sympathetic nervous system that control the sweat glands. This study compares the clinical consequences of uniportal and multiportal thoracic endoscopic thoracic sympathectomy (ETS), in cases of severe palmar and axillary hyperhidrosis.
Methods: In this retrospective study, forty-one patients who were diagnosed as severe palmar and axillary primary hyperhidrosis were analyzed. These underwent multiportal ETS between 2015 and 2020 at our thoracic surgery clinic. They were divided into two groups, 24 as uniportal (58.5%) and 17 as multiportal (41.5%). They were compared in terms of the length of hospital stay, the initial complications and possible recurrences after three months. Descriptive statistics were used to evaluate stratified and continuous variables.
Results: There was no significant difference in moderate pain between the two groups. There was a significant difference between the two groups in terms of 3 days or more hospitalization. There were no significant difference related to the rate of complications such as ptosis, Horner syndrome, increased duration of surgery and recurrence rate of hyperhidrosis 3 months after surgery. Some mild to moderate side effects disappeared spontaneously at 6-month follow-up.
Conclusion: The results showed that uniportal and multiportal endoscopic thoracoscopic sympathectomy (EST) are very effective, safe and minimally invasive methods for the treatment of palmar and axillary hyperhidrosis. Compared to the multiportal approach, uniportal EST causes less postoperative pain and less surgical duration.
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Lee ACH, Ferguson MK. Knowledge of surgical management of hyperhidrosis among primary care physicians and the general public. Interact Cardiovasc Thorac Surg 2022; 34:791-798. [PMID: 35015865 PMCID: PMC9070533 DOI: 10.1093/icvts/ivab371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/21/2021] [Accepted: 12/08/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Our study examined attitudes towards initial management of hyperhidrosis, willingness to seek surgical consultation and knowledge of an appropriate specialty for surgical consultation among primary care physicians and the general public. METHODS An online survey was sent to all general medicine and paediatric residents and attending physicians at our academic medical centre. Participants were provided with a clinical scenario of palmar hyperhidrosis and were asked to select among initial management options and preferences for surgical consultation if patients failed non-operative management. To assess the general public's perspective, workers from Amazon Mechanical Turk were recruited to complete a similar survey. RESULTS The majority of primary care physicians (31/53; 58%) would prescribe topical aluminium chloride for palmar hyperhidrosis, whereas 28 of 53 (53%) would refer such patients to dermatology. Twenty-three of 53 (43%) physicians would refer such patients to surgery if conservative management failed: 18 (78%) to plastic surgery, 4 (17%) to general surgery and none to thoracic surgery. The majority of workers (130/205; 63.4%) would seek primary care treatment for palmar hyperhidrosis. Over half (113/205; 55%) would seek surgical consultation if conservative management failed: 65 (58%) general surgery and 15 (13%) neurosurgery, with only 8 (7%) selecting thoracic surgery. CONCLUSIONS Neither primary care physicians nor the general public recognize the role of thoracic surgeons in managing primary focal hyperhidrosis when medical management fails. Education of physicians and the public may mitigate this knowledge gap.
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Affiliation(s)
- Andy Chao Hsuan Lee
- Section of Thoracic Surgery, Department of Surgery, The University of Chicago, Chicago, IL, USA
| | - Mark K Ferguson
- Section of Thoracic Surgery, Department of Surgery, The University of Chicago, Chicago, IL, USA
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Kermenli T, Gündoğdu Z, Cihangiroğlu Y. Long-term Effect of Endothoracic Sympathectomy with Clipping Method on Quality of Life in Primary Hyperhidrosis and Facial Flushing. Indian J Surg 2022. [DOI: 10.1007/s12262-021-02896-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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A Practical Approach to the Diagnosis and Treatment of Palmar Hyperhidrosis. Plast Reconstr Surg Glob Open 2022; 10:e4172. [PMID: 35265447 PMCID: PMC8901220 DOI: 10.1097/gox.0000000000004172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
Palmar hyperhidrosis (PH), a condition characterized by excess sweating of the palms, is a common concern that presents to the plastic surgeon, which can have major impacts on patient confidence and quality of life. While several studies summarize treatment options for hyperhidrosis in general, few outline the therapeutic options available specifically for PH.
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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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Turhan K, Kavurmaci Ö, Akçam Tİ, Ergönül AG, Özdil A, Çakan A, Çağirici U. Long-Term Outcomes and Course of Compensatory Sweating after Endoscopic Sympathicotomy. Thorac Cardiovasc Surg 2021; 70:167-172. [PMID: 34044464 DOI: 10.1055/s-0041-1728777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Endoscopic thoracic sympathicotomy is an effective approach to the treatment of idiopathic localized hyperhidrosis, and compensatory sweating is the main reason for patient dissatisfaction. Our study discusses both the long-term outcomes of sympathicotomy and the course of compensatory sweating. METHODS Patients with palmar and/or axillary hyperhidrosis who were operated by the same surgical team between January 2008 and December 2014 were included in the study. After at least 5 years (60 months) from operation, patients were questioned about their treatment outcomes by using an original survey form. RESULTS Of the 137 patients included in the study, 88 (64.2%) were female and 49 (35.8%) were male. The mean time from the operation to the survey interview was 80.9 ± 14.1 (64-136) months. After operation, complaints disappeared in 95.1% of the patients, and decreased in 4.9% with palmar hyperhidrosis. Complaints completely disappeared in 12.9% and decreased in 81.7% of the patients with axillary hyperhidrosis. Ninety-seven (70.8%) of the patients described increased sweating in some parts of their body after operation but only 47 reached an uncomfortable intensity. The number of patients who regretted the operation due to the compensatory sweating was 13 (9.5%). The patients' overall scoring of the operation and procedure was calculated as 8.0 ± 2.1 (0-10 points) out of 10. CONCLUSION Endoscopic thoracic sympathicotomy's long-term outcomes are also satisfactory in the treatment of palmar and axillary hyperhidrosis. Compensatory sweating may decrease over time, only a minority of patients will express regret at undergoing the treatment.
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Affiliation(s)
- Kutsal Turhan
- Department of Thoracic Surgery, Ege University School of Medicine, Bornova, Turkey
| | - Önder Kavurmaci
- Department of Thoracic Surgery, University of Health Sciences Bozyaka Izmir Training and Research Hospital, Izmir, Turkey
| | - Tevfik İlker Akçam
- Department of Thoracic Surgery, Ege University School of Medicine, Bornova, Turkey
| | - Ayşe Gül Ergönül
- Department of Thoracic Surgery, Ege University School of Medicine, Bornova, Turkey
| | - Ali Özdil
- Department of Thoracic Surgery, Ege University School of Medicine, Bornova, Turkey
| | - Alpaslan Çakan
- Department of Thoracic Surgery, Ege University School of Medicine, Bornova, Turkey
| | - Ufuk Çağirici
- Department of Thoracic Surgery, Ege University School of Medicine, Bornova, Turkey
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Increased Incidence of Premenstrual Syndrome in Females with Palmar Hyperhidrosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094697. [PMID: 33925001 PMCID: PMC8124344 DOI: 10.3390/ijerph18094697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/24/2021] [Accepted: 04/25/2021] [Indexed: 01/23/2023]
Abstract
Background: Premenstrual syndrome (PMS) is a common disorder affecting the quality of life of women of reproductive age. In a previous study, sex hormone imbalances and alterations in autonomic function were present in PMS, with parasympathetic dysfunction and sympathetic overactivity during the late luteal phase. Palmar hyperhidrosis (PH) presents with oversweating, heat and emotional stimulation, sympathetic hyperactivity and parasympathetic hypofunction. We hypothesized that the incidence of PMS is increased in females with PH. Methods: Data were retrieved from the Taiwanese National Health Insurance Database. The patients with PH were identified by the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) disease code 780.8. Female patients matched by age and index day were used as the control group. The incidence of PMS was considered an outcome by the ICD-9-CM disease code 625.4. The factors related to PMS were analyzed by Cox regression. Results: The adjusted hazard ratio for the incidence of PMS was 1.276 (95% confidence interval: 1.05–1.488) in females with PH. Conclusions: This study found a positive correlation between PMS and female PH patients. Patients and physicians must understand the relationship of PMS with autonomic function alterations and other risk factors to prevent this problematic disorder.
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Chen LWY, Goh M, Goh R, Chao YK, Huang JJ, Kuo WL, Sung CWH, Chuieng-Yi Lu J, Chuang DCC, Chang TNJ. Robotic-Assisted Peripheral Nerve Surgery: A Systematic Review. J Reconstr Microsurg 2021; 37:503-513. [PMID: 33401326 DOI: 10.1055/s-0040-1722183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Robotic-assisted techniques are a tremendous revolution in modern surgery, and the advantages and indications were well discussed in different specialties. However, the use of robotic technique in plastic and reconstructive surgery is still very limited, especially in the field of peripheral nerve reconstruction. This study aims to identify current clinical applications for peripheral nerve reconstruction, and to evaluate the advantages and disadvantages to establish potential uses in the future. METHODS A review was conducted in the literatures from PubMed focusing on currently published robotic peripheral nerve intervention techniques. Eligible studies included related animal model, cadaveric and human studies. Reviews on robotic microsurgical technique unrelated to peripheral nerve intervention and non-English articles were excluded. The differences of wound assessment and nerve management between robotic-assisted and conventional approach were compared. RESULTS Total 19 studies including preclinical experimental researches and clinical reports were listed and classified into brachial plexus reconstruction, peripheral nerve tumors management, peripheral nerve decompression or repair, peripheral nerve harvesting, and sympathetic trunk reconstruction. There were three animal studies, four cadaveric studies, eight clinical series, and four studies demonstrating clinical, animal, or cadaveric studies simultaneously. In total 53 clinical cases, only 20 (37.7%) cases were successfully approached with minimal invasive and intervened robotically; 17 (32.1%) cases underwent conventional approach and the nerves were intervened robotically; 12 (22.6%) cases converted to open approach but still intervened the nerve by robot; and 4 (7.5%) cases failed to approach robotically and converted to open surgery entirely. CONCLUSION Robotic-assisted surgery is still in the early stage in peripheral nerve surgery. We believe the use of the robotic system in this field will develop to become popular in the future, especially in the fields that need cooperation with other specialties to provide the solutions for challenging circumstances.
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Affiliation(s)
- Lisa Wen-Yu Chen
- Department of Plastic and Reconstructive Surgery, Linkou Medical Center and Chang-Gung University, School of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Mei Goh
- Department of Plastic and Reconstructive Surgery, Gold Coast University Hospital, Queensland, Australia
| | - Raymond Goh
- Valley Plastic Surgery, Queensland, Australia
| | - Yin-Kai Chao
- Division of Thoracic Surgery, Linkou Medical Center and Chang-Gung University, School of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jung-Ju Huang
- Department of Plastic and Reconstructive Surgery, Linkou Medical Center and Chang-Gung University, School of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Ling Kuo
- Division of Breast Surgery, Department of General Surgery, Chang Gung Memorial Hospital, Linkou and Taipei, Taiwan
| | - Cheyenne Wei-Hsuan Sung
- Department of Plastic and Reconstructive Surgery, Linkou Medical Center and Chang-Gung University, School of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Johnny Chuieng-Yi Lu
- Department of Plastic and Reconstructive Surgery, Linkou Medical Center and Chang-Gung University, School of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - David Chwei-Chin Chuang
- Department of Plastic and Reconstructive Surgery, Linkou Medical Center and Chang-Gung University, School of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tommy Nai-Jen Chang
- Department of Plastic and Reconstructive Surgery, Linkou Medical Center and Chang-Gung University, School of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Kamikava DYF, Wolosker N, da Silva MFA, de Campos JRM, Puech-Leão P. Symptoms of anxiety and depression in patients with primary hyperhidrosis and its association with the result of clinical treatment with oxybutynin. Clinics (Sao Paulo) 2021; 76:e2892. [PMID: 34190853 PMCID: PMC8221552 DOI: 10.6061/clinics/2021/e2892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Studies have identified correlations between the psychological characteristics of individuals with primary hyperhidrosis (HH), the degree of sweating, and the quality of life (QoL). This study aimed to evaluate the prevalence of anxiety and depression symptoms in patients with HH before and after oxybutynin treatment. METHODS Data were collected from 81 patients. Palmar or axillary HH was the most frequent complaint (84.0%). All patients were evaluated before the medication was prescribed and after five weeks of treatment. The Beck Depression Inventory and Beck Anxiety Inventory were used to evaluate depression and anxiety. RESULTS Improvement in HH occurred in 58 patients (71.6%), but there was no improvement in 23 patients (28.4%). The QoL before treatment in all patients was either "poor" or "very poor." Patients who experienced improvement in sweating rates also experienced a greater improvement in QoL than patients who did not experience improvement in sweating at the main site (87.9% vs. 34.7%) (p<0.001). A total of 19.7% of patients showed an improvement in their level of depression, and a total of 46.9% of patients exhibited improvements in their level of anxiety. A significant correlation was observed between sweating and anxiety (p=0.015). CONCLUSION Patients with HH who experienced improvements in sweating immediately after treatment with oxybutynin exhibited small improvements in their levels of depression and significant improvements in their levels of anxiety and QoL.
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Affiliation(s)
- Débora Yumi Ferreira Kamikava
- Divisao de Psicologia, Instituto Central, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Nelson Wolosker
- Disciplina de Cirurgia Vascular e Endovascular, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
| | | | - José Ribas Milanez de Campos
- Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
- Disciplina de Cirurgia Toracica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Pedro Puech-Leão
- Disciplina de Cirurgia Vascular e Endovascular, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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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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Parrish C, Waldbaum B, Coleman D, Blevins C, Rodgers K, Lee B, Ober C, Hudhud L, Cox S, Griffin C, Chew S, Chen B, Brock M. Microwave Thermolysis Reduces Generalized and Social Anxiety in Young Adults With Axillary Hyperhidrosis. Lasers Surg Med 2020; 52:842-847. [PMID: 32175622 DOI: 10.1002/lsm.23229] [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] [Accepted: 02/23/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Hyperhidrosis (HH) is associated with impairments in quality of life (QOL) and elevated anxiety. Microwave thermolysis is a newer treatment that reduces sweating, yet effects on QOL and emotional symptoms have not been examined. Two treatment sessions are recommended to achieve 80% amelioration of clinical HH. We hypothesized that microwave thermolysis would reduce sweat severity, improve QOL, and reduce anxiety in young adults suffering from axillary HH in a prospective clinical trial. STUDY DESIGN/MATERIALS AND METHODS We enrolled 24 young adults (mean age = 23.57 years, 54% female) with elevated scores on the Hyperhidrosis Disease Severity Scale. All participants received one session of microwave thermolysis, and 83% received two sessions. Participants completed measures of sweat severity, QOL, generalized anxiety, social anxiety, social avoidance, and anxious/depressive mood symptoms at baseline; post-first treatment; and following second treatment. RESULTS At baseline, all participants had severe sweating; 87.5% had impaired QOL, 75% had elevated social anxiety, 50% with generalized anxiety, 48% with social avoidance, and 38% with anxious/depressed mood. Paired samples t tests indicated significant improvements from baseline to first procedure, including decreased sweating (t(21) = 5.68, P < 0.001), improved QOL (t(23) = 4.97, P < 0.001), and decreased generalized anxiety (t(23) = 8.11, P < 0.001), social anxiety (t(22) = 4.55, P < 0.001), mood symptoms (t(21) = 3.81, P = 0.001), and social avoidance (t(22) = 3.12, P = 0.005). After second treatment, further improvements were noted in sweating (t(18) = 3.28, P = 0.004) and QOL (t(18) = 3.83, P = 0.003), and a marginal trend for generalized anxiety (t(19) = 1.96, P = 0.064). CONCLUSION There were significant improvements in sweat severity, skin-specific QOL, generalized anxiety, social anxiety, anxious/depressive symptoms, and social avoidance. The majority of the psychosocial benefit appears to emerge after one treatment of microwave thermolysis, whereas the level of sweat severity and QOL continued to show further improvements after a second treatment. Results would suggest that although two microwave thermolysis sessions are needed for maximal treatment optimization of axillary HH, patients may experience significant benefits in improving psychosocial functioning after just one session. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.
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Affiliation(s)
- Carisa Parrish
- Department of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
| | - Benjamin Waldbaum
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland, 21287
| | - Daniel Coleman
- Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
| | - Carley Blevins
- Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
| | - Kristen Rodgers
- Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
| | - Beverly Lee
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland, 21287.,Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
| | - Cecily Ober
- Rosalind Franklin Medical School, Chicago, Illinois, 60064
| | - Layla Hudhud
- Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
| | - Solange Cox
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
| | | | - Sunmi Chew
- Miramar Labs Inc., Santa Clara, California, 95051
| | - Bo Chen
- Miramar Labs Inc., Santa Clara, California, 95051
| | - Malcolm Brock
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland, 21287.,Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
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Han JW, Kim JJ, Kim YH, Kim IS, Jeong SC. New sympathicotomy for prevention of severe compensatory hyperhidrosis in patients with primary hyperhidrosis. J Thorac Dis 2020; 12:765-772. [PMID: 32274143 PMCID: PMC7138987 DOI: 10.21037/jtd.2019.12.91] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Primary hyperhidrosis (PH) is characterized by excessive and uncontrollable secretion in the eccrine sweat glands of the craniofacial region, armpits, hands, and feet. Sympathicotomy is the most effective treatment for severe PH; however, compensatory hyperhidrosis (CH) remains the most devastating postoperative complication. The purpose of the present study was to suggest a new sympathicotomy method for PH to prevent severe CH. Methods From March 2014 to December 2018, a total of 212 patients were included in the study. R2 (53 cases) sympathicotomy for craniofacial hyperhidrosis and R3 (79 cases) or R4 (80 cases) sympathicotomy for palmar hyperhidrosis using the thoracoscopic technique were performed, respectively. Sympathicotomy was performed using two different methods (conventional 145 cases and new 67 cases). Expanded sympathicotomy was performed as the new method (67 cases), which was divided into two groups (partial- and full-expanded sympathicotomy). Operative effectiveness was evaluated by a reduction in percentage of post-operative sweating compared with pre-operative sweating and groups were divided into complete and incomplete sweat reduction characteristics. Complete sweat reduction was defined as sweat reduction ≥80% compared with preoperative sweating. The degrees of CH were classified as negligible, mild bothering (tolerable), and severe bothering (intolerable). Data on preoperative subject characteristics, disease status, operative technique, and postoperative outcomes were gathered using medical records and telephone surveys. Results According to sympathicotomy techniques, the conventional procedure (non-expanded sympathicotomy) was performed in 145 cases and the new expanded sympathicotomy procedure was performed in 67 cases (partial-expanded sympathicotomy 28 cases; full-expanded sympathicotomy 39 cases). Craniofacial hyperhidrosis was significantly more prevalent in the older group and in female patients (P<0.001 and P=0.007, respectively). Sympathicotomy was significantly more effective in palmar hyperhidrosis than craniofacial hyperhidrosis (P<0.001). CH was significantly more severe in craniofacial hyperhidrosis than palmar hyperhidrosis after sympathicotomy (P<0.001). In craniofacial hyperhidrosis, there was no significant difference in sweat reduction and CH between conventional and the expanded sympathicotomy techniques (P=0.177 and P=0.474, respectively). In palmar hyperhidrosis, there was no significant difference in sweat reduction between the conventional and the expanded sympathicotomy (P=0.178), however, degree of CH in the conventional technique was significantly more severe than in the expanded technique (P=0.001). Regarding comparison between partial- and full-expanded sympathicotomy, there was no significant difference in sweat reduction between partial-, and full-expanded sympathicotomy; however, CH was significantly more severe in partial-expanded sympathicotomy (craniofacial hyperhidrosis P=0.006; palmar hyperhidrosis P<0.001). Irrespective of hyperhidrosis types, there was no significant difference in sweat reduction between full-expanded and the others (non-expanded and partial-expanded sympathicotomy), however, full-expanded sympathicotomy showed a significantly less degree of CH than non-expanded and partial-expanded sympathicotomy (craniofacial, P=0.002; palmar, P<0.001). Conclusions Full-expanded sympathicotomy is a safe and feasible treatment that shows a significant decrease in the degree of CH with the same effect in sweat reduction in both craniofacial and palmar hyperhidrosis. Importantly, no severe CH developed after a full-expanded sympathicotomy without any major postoperative complications.
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Affiliation(s)
- Jung Wook Han
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Geumo-dong, Uijeongbu, Gyeonggi-do, Republic of Korea
| | - Jae Jun Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Geumo-dong, Uijeongbu, Gyeonggi-do, Republic of Korea
| | - Yong Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Geumo-dong, Uijeongbu, Gyeonggi-do, Republic of Korea
| | - In Sub Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Geumo-dong, Uijeongbu, Gyeonggi-do, Republic of Korea
| | - Seong Cheol Jeong
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Geumo-dong, Uijeongbu, Gyeonggi-do, Republic of Korea
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Soares TJ, Dias PG, Sampaio SM. Impact of Video-Assisted Thoracoscopic Sympathectomy and Related Complications on Quality of Life According to the Level of Sympathectomy. Ann Vasc Surg 2019; 63:63-67.e1. [PMID: 31629129 DOI: 10.1016/j.avsg.2019.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/07/2019] [Accepted: 07/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Primary hyperhidrosis is defined as excessive sweating of idiopathic etiology, associated with sympathetic hyperactivity, which greatly impacts patients' quality of life (QoL). The definitive treatment for palmar and axillary hyperhidrosis (PAH) is video-assisted thoracic sympathectomy (VATS). The objective of this study was to evaluate the quality of life of patients with PAH before and after VATS according to the level of sympathectomy performed, as well as the presence of compensatory hyperhidrosis (CH) and other complications. METHODS All patients who underwent VATS in our vascular surgery department between January 2011 and December 2016 were included in the analysis. From 120 contact attempts, 88 interviews were carried out. Patients were divided into 2 groups according to the intervened thoracic level: high thoracic ganglion (HTG; T2, T2-T3, T2-T3-T4; n = 68) and low thoracic ganglion (LTG; T3, T3-T4, T4; n = 20). The questionnaire evaluated preoperative PAH severity, the presence of CH, preoperative and postoperative QoL, and postoperative satisfaction. RESULTS The median age of patients was 29 years, and the median follow-up period was 32 months (IQR of 34 months). Most patients had severe or very severe PAH (97.7%) and preoperative QoL was bad or very bad (95.5%). Postoperatively, QoL was significantly improved in all domains evaluated, with no differences observed between the groups. The overall percentage of complications was 11.4%, mostly pneumothorax, but there was a significantly lower incidence of complications in the HTG group (P = 0.029). Compensatory hyperhidrosis developed in 85.2% of cases, but it was only considered intolerable in 10.2%. The incidence of CH was 82.4% in the HTG group and 95% in the LTG group, with no statistically significant differences between the groups (P = 0.147). CONCLUSIONS Palmar and axillary hyperhidrosis severely affects QoL, and video-assisted thoracic sympathectomy was proven to be effective regardless of the target ganglion resected. Although CH was frequent, it was tolerated in most cases.
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Affiliation(s)
- Tiago J Soares
- Angiology and Vascular Surgery Unit, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal.
| | - Paulo G Dias
- Angiology and Vascular Surgery Unit, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Sérgio M Sampaio
- Angiology and Vascular Surgery Unit, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal
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Chen S, Zhang P, Chai T, Shen Z, Kang M, Lin J. T3 versus T4 video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e17272. [PMID: 31626085 PMCID: PMC6824754 DOI: 10.1097/md.0000000000017272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Palmar hyperhidrosis (PH) is a common sympathetic disorder that reduces patient' quality of life. Video-assisted thoracoscopic sympathectomy (VTS) is a popular and effective treatment for PH. However, there is substantial controversy about the treatment of PH with VTS at the T3 or T4 level. We will compare the quality metrics of VTS at T3 versus T4 to determine the optimal level for VTS. METHODS We will search PubMed, Scopus, Web of Science, Embase, Cancerlit, the Cochrane Central Register of Controlled Trials, and the Google Scholar databases for relevant clinical trials published in any language before March 31, 2019. Randomized controlled trials (RCTs), quasi-RCTs, propensity score-matched comparative studies, and prospective cohort studies of interest, published or unpublished, that meet the inclusion criteria will be included. Subgroup analysis of the type of operation, sex of patient, and ethnicity of patient will be performed. RESULTS The results of this study will be published in a peer-reviewed journal. CONCLUSIONS The results of this study will provide reliable evidence for the development of optimal treatment strategies for patients with PH. Owing to the characteristics of disease and intervention methods, randomized controlled trials may not be sufficient. We will include high-quality nonrandomized controlled trials, but this may lead to high heterogeneity and may affect the reliability of the results. PROSPERO REGISTRATION NUMBER CRD42018116607.
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Affiliation(s)
- Sui Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Peipei Zhang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Tianci Chai
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of anesthesiology, Xinyi People's Hospital, Xuzhou, China
| | - Zhimin Shen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Mingqiang Kang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jiangbo Lin
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
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No sweat: Favorable outcomes of hyperhidrosis surgery with age. J Thorac Cardiovasc Surg 2018; 156:1759-1760. [PMID: 30248806 DOI: 10.1016/j.jtcvs.2018.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 07/21/2018] [Indexed: 11/22/2022]
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