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Pei G, Meng S, Yang Y, Wang X, Liu Q, Wang S, Huang Y. Anatomical variations of the thoracic sympathetic ganglions and their effects on sympathicotomy for primary palmar hyperhidrosis. Clin Auton Res 2023; 33:111-120. [PMID: 37017809 PMCID: PMC10182923 DOI: 10.1007/s10286-023-00932-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/13/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE The results and side effects of sympathicotomy for primary palmar hyperhidrosis (PPH) can vary due to anatomical variations of the sympathetic ganglions. The aim of our study was to clarify anatomical variations of the sympathetic ganglions by near-infrared (NIR) thoracoscopy and determine their effects on sympathicotomy for PPH. METHODS The cases of 695 consecutive patients with PPH treated with either R3 or R4 sympathicotomy either by normal thoracoscopy or by NIR fluorescent thoracoscopy between March 2015 and June 2021 were retrospectively reviewed and followed up. RESULTS The variation rate of third and fourth ganglions was 14.7% and 13.3% on the right side and 8.3% and 11.1% on the left side. Real T3 sympathicotomy (RTS3) was more effective than real T4 sympathicotomy (RTS4) in the short-term and long-term follow-up (p < 0.001 and p < 0.001, respectively). RTS3 was more satisfactory than RTS4 in the long-term follow-up (p = 0.03), but no significant difference was found in the short-term follow-up (p = 0.24). The incidence and severity of compensatory hyperhidrosis (CH) in the areas of the chest and back in the RTS4 group were significantly lower than those in the RTS3 group according to both the short-term results (12.92% vs. 26.19%, p < 0.001; 17.97% vs. 33.33%, p = 0.002, respectively) and the long-term results (19.66% vs. 28.57%, p = 0.017; 21.35% vs. 34.52%, p < 0.001, respectively). CONCLUSIONS RTS3 may be more effective than RTS4 for PPH. However, RTS4 appears to be associated with a lower incidence and severity of CH in the areas of the chest and back than RTS3. NIR intraoperative imaging of thoracic sympathetic ganglions may improve the quality of sympathicotomy surgeries.
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Affiliation(s)
- Guotian Pei
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), No 29, Zhongguancun Street, Haidian District, Beijing, 100080, China
| | - Shushi Meng
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), No 29, Zhongguancun Street, Haidian District, Beijing, 100080, China
| | - Yingshun Yang
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), No 29, Zhongguancun Street, Haidian District, Beijing, 100080, China
| | - Xiao Wang
- Shanxi Key Laboratory of Artificial Intelligence-Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Shanxi, China
| | - Qiang Liu
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), No 29, Zhongguancun Street, Haidian District, Beijing, 100080, China
| | - Shuai Wang
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), No 29, Zhongguancun Street, Haidian District, Beijing, 100080, China
| | - Yuqing Huang
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), No 29, Zhongguancun Street, Haidian District, Beijing, 100080, China.
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Vanlommel J, Van Look L, Peetermans M, Uyttebroek L, van Nassauw L, Van Schil P. Anatomical variations of the upper thoracic sympathetic chain: a review. Eur J Cardiothorac Surg 2021; 61:515-522. [PMID: 34676399 DOI: 10.1093/ejcts/ezab445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The objective of this study is to provide a thorough overview of the anatomical variations of the upper thoracic sympathetic trunk to improve clinical results of upper thoracic sympathectomy. In addition, this study strives for standardization of future studies regarding the anatomy of the upper thoracic sympathetic chain. METHODS The Web of Science, PubMed and Google Scholar databases were searched using keywords, alone or combined, regarding the anatomy of the thoracic sympathetic chain. The search was limited to studies performed in humans. RESULTS Fifteen studies were finally included. Cervicothoracic ganglion and nerve of Kuntz were present in 77% and 53%, respectively. The upper thoracic ganglia were predominantly located in their corresponding intercostal space with a relatively downwards shift at the lower thoracic levels. The right sympathetic trunk is prone to have more communicating rami then the left. The lower levels of ganglia tend to have more normal rami. No clear pattern was found concerning the presence of the ascending rami and there was a decrease in the number of descending rami as the chain runs caudally. The intercostal rami remain a rare anatomical variation. CONCLUSIONS This study presents an overview of the anatomy of the upper thoracic sympathetic chain. Its results may guide upper thoracic sympathectomy to improve clinical results. This review also provides a baseline for future studies on anatomical variations of the thoracic sympathetic trunk. More uniform reporting is necessary to compare different anatomical studies.
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Affiliation(s)
- Jens Vanlommel
- Department ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Lawrence Van Look
- Department ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Maxime Peetermans
- Department ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Leen Uyttebroek
- Department ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Luc van Nassauw
- Department ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Paul Van Schil
- Department ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
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Wolosker N, Faustino CB, da Silva MFA, de Campos JRM, Kauffman P. Current treatment options for craniofacial hyperhidrosis. J Vasc Bras 2020; 19:e20190152. [PMID: 34211510 PMCID: PMC8218019 DOI: 10.1590/1677-5449.200152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hyperhidrosis (HH) is characterized by sweating exceeding the amount necessary to meet the thermal regulation and physiological needs of the body. Approximately 9.41% of individuals with HH have craniofacial hyperhidrosis (FH). The present study aims to review the most current data in the literature regarding craniofacial hyperhidrosis, including pathophysiology, diagnosis and clinical presentation, treatment options (clinical and surgical), and outcomes. VATS (videothoracoscopy sympathectomy) is considered the gold standard for definitive treatment of axillary or palmar hyperhidrosis. Recently, several studies have shown the usefulness of clinical treatment with oxybutynin hydrochloride, leading to clinical improvement of HH in more than 70% of users. Both clinical and surgical treatment of craniofacial hyperhidrosis have good results. However, surgical treatment of FH is associated with more complications. Clinical treatment with oxybutynin hydrochloride yields good results and can be the first therapeutic option. When the patient is not satisfied with this treatment and has good clinical conditions, surgical treatment can be used safely.
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Affiliation(s)
- Nelson Wolosker
- Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.,Universidade de São Paulo - USP, Faculdade de Medicina, Departamento de Cirurgia Vascular e Endovascular, São Paulo, SP, Brasil
| | | | | | - José Ribas Milanez de Campos
- Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.,Universidade de São Paulo - USP, Faculdade de Medicina, Departamento de Cirurgia Torácica, São Paulo, SP, Brasil
| | - Paulo Kauffman
- Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.,Universidade de São Paulo - USP, Faculdade de Medicina, Departamento de Cirurgia Vascular e Endovascular, São Paulo, SP, Brasil
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Pei G, Liu Y, Liu Q, Min X, Yang Y, Wang S, Liu J, Wang J, Huang Y. The safety and feasibility of intraoperative near-infrared fluorescence imaging with indocyanine green in thoracoscopic sympathectomy for primary palmar hyperhidrosis. Thorac Cancer 2020; 11:943-949. [PMID: 32061064 PMCID: PMC7113049 DOI: 10.1111/1759-7714.13345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 01/06/2023] Open
Abstract
Background We investigated the safety and feasibility of intraoperative near‐infrared (NIR) imaging using indocyanine green (ICG) during sympathectomy in the management of primary palmar hyperhidrosis (PPH). Methods We performed a retrospective review of 142 patients (ICG group) who underwent endoscopic thoracic sympathectomy (ETS) between February 2018 and April 2019. All patients received a 5 mg/kg infusion of ICG 24 hours preoperatively. The vital signs before and after ICG injection and adverse reactions were recorded. Meanwhile, 498 patients (Non‐ICG group) who underwent ETS by normal thoracoscopy during August 2017 to April 2019 were also reviewed to compare the abnormal white blood cell (WBC) counts, alanine transaminase (ALT), aspartate transaminase (AST), blood urea nitrogen (BUN), and creatinine (Cr) levels before and after operation between two groups. Results For ICG group, the vital signs including body temperature, heart rate and blood pressure before and after ICG injection were stable. There was no significant difference in the abnormal WBC counts, ALT, AST, BUN, and Cr levels before and after operation between two groups. Only one patient had mild adverse reaction (0.7%) after ICG injection. The visibility rate of all sympathetic ganglions was 96.7% (1369/1415). The visibility rate from T1 to T5 was 98.23% (278/283), 98.23% (278/283), 97.17% (275/283), 95.76% (271/283), and 94.35% (267/283), respectively. There was no significant difference in the visibility rate with regard to age, gender, height, weight, body mass index, and PPH grade. Conclusions NIR fluorescence imaging with ICG for identifying sympathetic ganglions is relatively safe and feasible. Key points • Significant findings of the study. NIR fluorescence imaging with ICG for identifying sympathetic ganglions is relatively safe and feasible. • What this study adds. This technology may take the place of the rib‐oriented method as standard practice for the precise localization of sympathetic ganglions, and may improve the effect of sympathectomies.
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Affiliation(s)
- Guotian Pei
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, China
| | - Yanguo Liu
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Qiang Liu
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, China
| | - Xianjun Min
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, China
| | - Yingshun Yang
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, China
| | - Shuai Wang
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, China
| | - Jun Liu
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Jun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Yuqing Huang
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, China
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Chaudhry A, Kamali A, Herzka DA, Wang KC, Carrino JA, Blitz AM. Detection of the Stellate and Thoracic Sympathetic Chain Ganglia with High-Resolution 3D-CISS MR Imaging. AJNR Am J Neuroradiol 2018; 39:1550-1554. [PMID: 29853521 DOI: 10.3174/ajnr.a5698] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 04/19/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Despite the importance of the sympathetic nervous system in homeostasis and its putative role in various disease states, little is known regarding our ability to image the sympathetic chain and sympathetic chain ganglia, perhaps owing to their small size. In this retrospective study, we sought to evaluate the normal anatomy of the sympathetic chain ganglia and assess the detectability of the sympathetic chain and sympathetic chain ganglia on high-resolution 3D-CISS images. MATERIALS AND METHODS This study included 29 patients who underwent 3D-CISS MR imaging of the thoracic spine for reasons unrelated to abnormalities of the sympathetic nervous system. Patients with a prior spinal operation or visible spinal pathology were excluded. The sympathetic chain ganglia were evaluated using noncontrast 3D-CISS MR imaging. Statistical analyses included t tests and measures of central tendency. The Cohen κ statistic was calculated to evaluate interrater reliability. RESULTS The stellate ganglion and thoracic chain ganglia were identified in all subjects except at the T10-T11 and T11-T12 levels. The stellate ganglion was found inferomedial to the subclavian artery and anterior and inferior to the transverse process of C7 in all subjects. Thoracic sympathetic chain ganglia were identified ventral to the costovertebral junction in all subjects from T2 to T10. There was strong interobserver agreement for the detection of the sympathetic chain ganglia with κ > 0.80. The size, shape, and location of these structures corresponded with gross anatomic and surgical observations. CONCLUSIONS The thoracic sympathetic chain ganglia can be identified on precontrast 3D-CISS MR imaging. This technique may aid in the initial evaluation of stellate ganglion and/or sympathetic chain ganglia size and signal change for comparison in future studies.
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Affiliation(s)
- A Chaudhry
- From the Departments of Neuroradiology (A.C., A.K.)
| | - A Kamali
- From the Departments of Neuroradiology (A.C., A.K.)
| | - D A Herzka
- Department of Biomedical Engineering (D.A.H.), Johns Hopkins University, Baltimore, Maryland
| | - K C Wang
- Department of Diagnostic Radiology and Nuclear Medicine (K.C.W.), University of Maryland, School of Medicine, Baltimore, Maryland
- Imaging Service (K.C.W.), Baltimore VA Medical Center, Baltimore, Maryland
| | - J A Carrino
- Department of Radiology and Imaging (J.A.C.), Weill Cornell Medical College, Hospital for Special Surgery, New York, New York
| | - A M Blitz
- Radiology and Radiologic Sciences (A.M.B.), Johns Hopkins University School of Medicine, Baltimore, Maryland
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Does the addition of alcohol increase the efficacy of radiofrequency ablation of T2 and T3 sympathetic ganglia in hyperhidrosis? EGYPTIAN JOURNAL OF ANAESTHESIA 2017. [DOI: 10.1016/j.egja.2017.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
By the 1980s, endoscopy was in use by some groups in sympathetic denervation of the upper limbs with vascular indications. Low morbidity, cosmetic results, reduction in the incidence of Horner syndrome, and the shortened time in hospital made video-assisted thoracic sympathectomy (VATS) better accepted by those undergoing treatment for hyperhidrosis. Over the last 25 years, this surgical procedure has become routine in the treatment of hyperhidrosis, leading to a significant increase in the number of papers on the subject in the literature.
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Ramicotomy in Association With Endoscopic Sympathetic Blockade in the Treatment of Axillary Hyperhidrosis. Surg Laparosc Endosc Percutan Tech 2013; 23:223-8. [DOI: 10.1097/sle.0b013e31828a0aec] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Flores LP. Long-term outcomes associated to video-assisted thoracic sympathotomy for palmar-axillar subtype of the hyperhidrosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 70:398-403. [PMID: 22699534 DOI: 10.1590/s0004-282x2012000600003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 02/03/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Surgery for both palmar and axillar hyperhidrosis usually includes the interruption of the sympathetic chain in multiple levels. This study aimed to determine the long-term outcomes associated to video-assisted thoracic sympathotomy (VATS) of T2, T3 and T4 ganglia for these cases. METHODS Analysis of the outcomes obtained from 36 patients regarding the rate of resolution of the symptoms and the compensatory sweating (CS). All subjects were followed-up for 36 months. RESULTS Good outcomes were observed in 98.6% for palmar and 60% for axillary hyperhidrosis (p=0.0423), respectively. Of the subjects, 86% reported some postoperative episode of CS, however only 45% (p=0.0031) still noticed it at the end of the follow-up period. CONCLUSIONS VATS is effective for the excessive palmar sweating, whereas it is fully efficient for only two thirds of the cases sustaining associated axillar hyperhidrosis. CS is expected as a rule following the proposed operative protocol, however it is usually self-limited.
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Affiliation(s)
- Leandro Pretto Flores
- Section of Neurological Surgery, Santa Helena Hospital. Unit of Neurosurgery, Hospital de Base do Distrito Federal. Post-Graduate Program in Medical Science, University of Brasília (UnB), Brasília DF, Brazil.
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Sympathetic chain clipping for hyperhidrosis is not a reversible procedure. Surg Endosc 2011; 26:1258-63. [DOI: 10.1007/s00464-011-2023-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 10/17/2011] [Indexed: 11/26/2022]
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Guidelines on surgery of the thoracic sympathetic nervous system. Arch Bronconeumol 2011; 47:94-102. [PMID: 21342743 DOI: 10.1016/j.arbres.2010.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 05/29/2010] [Indexed: 11/23/2022]
Abstract
Thoracic sympathetic nervous system (TSNS) surgery has increased in importance in the last few years, generating great expectations among the general population and the scientific community. This has been due to the excellent results obtained by videothoracoscopy-assisted thoracic sympathectomy in the treatment of essential hyperhidrosis and other TSNS disorders. This minimally invasive surgical technique has been shown to be effective, and with a low morbidity it is accepted as one of the best therapeutic options for the treatment of palmar and bilateral axillary hyperhidrosis and the number of patients consulting with the intention of having the operation has increased considerably. Although compensatory sweating, which is occasionally intense, often occurs after the surgery, this and other secondary effects of the technique are well tolerated by patients. The current evidence on TSNS and the treatment of essential hyperhidrosis is based on observational studies, making it difficult to compare series and draw conclusions. There has been much discussion on standardising the technique, defining the most favourable levels for clipping, and choosing the type of denervation with least secondary effects. This has led to the need to draw up these guidelines which should clarify and standardise the criteria for managing patients with disorders of TSNS.
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Haam S, Kim D, Hwang J, Paik H, Lee D. An anatomical study of the relationship between the sympathetic trunk and intercostal veins of the third and fourth intercostal spaces during thoracoscopy. Clin Anat 2010; 23:702-6. [PMID: 20533514 DOI: 10.1002/ca.21001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The complexity of the anatomy of the sympathetic trunk and intercostal veins in the third and fourth intercostal space may lead to intraoperative or postoperative bleeding. The purpose of this study was to investigate the anatomical variations of the sympathetic trunk and intercostal veins in the third and fourth intercostal spaces. The size and crossing type of veins in the third and fourth intercostal spaces in 44 Korean patients with palmar hyperhidrosis were analyzed. We classified intercostal veins by their size (small, medium, and large) and crossing type (anterior or posterior to sympathetic nerve). Large intercostal veins susceptible to bleeding were found in 36.4 and 68.2% of patients in the right third and fourth intercostal spaces, respectively and in 2.3 and 4.5% of left third and fourth intercostal spaces, respectively. More than 80% of the left third and fourth intercostal veins were small. Anterior crossing intercostal veins, which often cause problems at the third and fourth right intercostal spaces, were found in 27.3% (third) and 15.9% (fourth). However, there were only two cases of anterior crossing veins on the left side. Large anterior crossing veins were found only on the right side. In conclusion, surgical procedures of the right sympathetic ganglia may have increased risks due to a higher frequency of large anterior crossing intercostal veins. Careful dissection is necessary to decrease the incidence of intraoperative or postoperative bleeding.
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Affiliation(s)
- Seokjin Haam
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Korea
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Zhang B, Li Z, Yang X, Li G, Wang Y, Cheng J, Tang X, Wang F. Anatomical variations of the upper thoracic sympathetic chain. Clin Anat 2009; 22:595-600. [PMID: 19418453 DOI: 10.1002/ca.20803] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim is to clearly delineate the upper thoracic sympathetic chains and neural connections between the chains and ventral rami of the thoracic nerves, and to provide an anatomical foundation for successful upper thoracic sympathicotomy for treating upper essential hyperhidrosis. The upper thoracic sympathetic chains, upper five intercostal nerves, and neural connections between them in 50 halves of 25 adult cadavers have been dissected, measured, and mapped. The stellate ganglion had an incidence of 80%. The second to the fourth thoracic sympathetic ganglia were commonly located in the corresponding intercostal spaces with the presence of 92%, 68%, and 50%, respectively. The incidence of the first and second intercostal rami was 40% and 6%, and that of the ascending or descending rami from the second, third and fourth ganglia was 54%, 24%, and 14%, respectively. Additional rami communicantes joined the ventral ramus of the 1st thoracic nerve proximal to the point where the latter gave a branch to the brachial plexus. The farthest horizontal distance from the sympathetic chain to the junction between the additional rami communicantes and the second to the fourth intercostal nerves was 29.1 mm. Only 16% of cadavers had similar anatomy bilaterally. Anatomical variations of the upper thoracic sympathetic trunk in relation to intercostal nerves, which may be one of the causes resulting in surgical failures and recurrences, were striking. Attention should be given to such anatomical variations when planning thoracic sympathicotomy.
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Affiliation(s)
- Bensi Zhang
- Department of Anatomy, Faculty of Basic Medicine, Dali University, Dali, Yunnan Province, China.
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Yazbek G, Wolosker N, Kauffman P, Campos JRMD, Puech-Leão P, Jatene FB. Twenty months of evolution following sympathectomy on patients with palmar hyperhidrosis: sympathectomy at the T3 level is better than at the T2 level. Clinics (Sao Paulo) 2009; 64:743-9. [PMID: 19690657 PMCID: PMC2728186 DOI: 10.1590/s1807-59322009000800006] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 05/04/2009] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To compare two surgical techniques (denervation levels) for sympathectomy using video-assisted thoracoscopy to treat palmar hyperhidrosis in the long-term. METHODS From May 2003 to June 2006, 60 patients with palmar hyperhidrosis were prospectively randomized for video-assisted thoracoscopic sympathectomy at the T2 or T3 ganglion level. They were followed for a mean of 20 months and were evaluated regarding their degree of improvement of palmar hyperhidrosis, incidence and severity of compensatory hyperhidrosis and its evolution over time, and quality of life. RESULTS Fifty-nine cases presented resolution of the palmar hyperhidrosis. One case of therapeutic failure occurred in the T3 group. Most of the patients presented an improvement in palmar hyperhidrosis, without any difference between the groups. Twenty months later, all patients in both groups presented some degree of compensatory hyperhidrosis but with less severity in the T3 group (p = 0.007). Compensatory hyperhidrosis developed in most patients during the first month after the operation, with incidence and severity that remained stable over time. An improvement in quality of life was seen starting from the first postoperative evaluation but without any difference between the groups. This improvement was maintained until the end of the follow-up. CONCLUSION Both techniques were effective for treating palmar hyperhidrosis. The most frequent complication was compensatory hyperhidrosis, which presented stable incidence and severity over the study period. Sympathectomy at the T3 level presented compensatory hyperhidrosis with less severity. Nevertheless, the improvement in quality of life was similar between the groups.
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Affiliation(s)
- Guilherme Yazbek
- Department of Vascular Surgery, Hospital das Clínicas, Faculdade de Medicinada Universidade de São Paulo, São Paulo/SP, Brazil.
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