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Loizzi D, Mongiello D, Bevilacqua MT, Raveglia F, Fiorelli A, Congedo MT, Ardò NP, Sollitto F. Surgical management of compensatory sweating: A systematic review. Front Surg 2023; 10:1160827. [PMID: 37035574 PMCID: PMC10073509 DOI: 10.3389/fsurg.2023.1160827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Endoscopic thoracic sympathectomy (ETS) surgery is a highly effective treatment of primary hyperhidrosis (PH) for the palms, face, axillae. Compensatory sweating (CS) is the most common and feared side effect of thoracic sympathectomy. CS is a phenomenon characterized by increased sweating in sites distal to the level of sympathectomy. Compensatory sweating is the main problem for which many patients give up surgery, losing the chance to solve their problem and accepting a poor quality of life. There are still no treatments that offer reliable solutions for compensatory sweating. The treatments proposed in the literature are scarce, with low case histories, and with uncertain results. Factors associated with CS are extension of manipulation of the sympathetic chain, level of sympathetic denervation, and body mass index. Therapeutic options include non surgical treatment and surgical treatment. Non surgical treatments include topical agents, botulinum toxin, systemic anticholinergics, iontophoresis. Surgical treatments include clip removal, extended sympathectomy and sympathetic chain reconstruction, although the efficacy is not well-established for all the methods. In this review we provide an overview of the treatments and outcomes described in the literature for the management of compensatory CS, with focus on surgical treatment.
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Affiliation(s)
- Domenico Loizzi
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
- Correspondence: Domenico Loizzi
| | - Diletta Mongiello
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | | | | | - Alfonso Fiorelli
- Department of Translation Medicine, Thoracic Surgery Unit, Università della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Maria Teresa Congedo
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Nicoletta Pia Ardò
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Francesco Sollitto
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
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Shen X, Luo Y, Hu H, Zhang S, Huang J, Xie S, Liu G, Feng H. Long-term results for palmar hyperhidrosis and palmar hyperhidrosis with axillary and/or plantar sweating: T3+T4 sympathicotomy vs. T4 sympathicotomy. Eur Surg 2022. [DOI: 10.1007/s10353-022-00786-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Filion W, Lamb C. Anatomical Variation of the Sympathetic Trunk and Aberrant Rami Communicantes and their Clinical Implications. Ann Anat 2022; 245:151999. [PMID: 36183936 DOI: 10.1016/j.aanat.2022.151999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/04/2022] [Accepted: 09/15/2022] [Indexed: 11/28/2022]
Abstract
Surgical interventions involving the sympathetic trunk are increasingly performed to alleviate symptoms of several disorders such as hyperhidrosis. Anatomical variation has been highlighted as one of the main causes behind surgical failure and symptoms recurrence following surgeries conducted on the chain or its surroundings. This study therefore aimed to record anatomical variants within spinal segments C8-T10 of the sympathetic trunk. Thirty Thiel-embalmed cadavers were investigated bilaterally. The stellate ganglion was recorded on 29 sides. Its size was significantly greater in males and on the right side when the coalescence extended to the subsequent ganglion. The intrathoracic nerve of Kuntz was observed on 21 sides and was significantly more prevalent in males. There was a significant positive association between the presence of this nerve and the descending ramus in the first intercostal space. Aberrant rami found between spinal root C8 and the ventral ramus of the first intercostal nerve were introduced as rami communicantes superi. Aberrant rami communicantes were recorded 50 times in total, of which 70% were found in males. Descending rami showed the highest prevalence in upper intercostal levels, especially in males within the first intercostal space. Aberrant neuronal pathways in upper levels were significantly more prevalent when the stellate ganglion was present. The scientific literature has proven to be stochastic as results were significantly higher in past studies in regard to some sympathetic variants. Anatomical findings of the current study as well as the inconsistency of previous data should be acknowledged and considered for better surgical planning.
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Affiliation(s)
- William Filion
- Centre for Anatomy and Human Identification, Medical Sciences Institute, University of Dundee, Scotland, United Kingdom; Faculty of Medicine and Health Sciences, McGill University, Quebec, Canada; University of Dundee, Nethergate, Dundee DD1 4HN - Scotland, United Kingdom.
| | - Clare Lamb
- Centre for Anatomy and Human Identification, Medical Sciences Institute, University of Dundee, Scotland, United Kingdom; University of Dundee, Nethergate, Dundee DD1 4HN - Scotland, United Kingdom.
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Bérard M, Leducq S, Laribi K, Samaran R, Maillard H. Factors associated with efficacy of botulinum toxin A injections in primary axillary hyperhidrosis: a retrospective study of ninety patients. Dermatol Ther 2022; 35:e15620. [DOI: 10.1111/dth.15620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/12/2022] [Accepted: 06/02/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | - Sophie Leducq
- Department of Dermatology and Reference Center for Rare Diseases and Vascular Malformations (MAGEC) CHRU Tours Tours France
| | - Kamel Laribi
- Department of Hematology Le Mans Hospital Le Mans France
| | - Romain Samaran
- Department of Dermatology Le Mans Hospital Le Mans France
| | - Hervé Maillard
- Department of Dermatology Le Mans Hospital Le Mans France
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Marinho-Junior CH, Czeczko NG, Cechin VL, Zeni JOV, Ribas-Filho JM. IS THERE NEURAL AND FUNCTIONAL RECOVERY AFTER CLIP REMOVAL IN CERVICAL EXPERIMENTAL SYMPATHECTOMY? ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2021; 34:e1582. [PMID: 34669878 PMCID: PMC8521783 DOI: 10.1590/0102-672020210002e1582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/04/2021] [Indexed: 11/25/2022]
Abstract
Background: The surgical treatment of hyperhidrosis by thoracic sympathectomy has brought, in addition to symptomatic relief for many, its main adverse effect: compensatory or reflex sweating. The clipping technique in place of the sympathetic nerve section gave rise to the hope of reversibility, but the positive results showed to be quite divergent, evidencing the academic deficiency regarding the study of this phenomenon.
Aim: To observe micro and macroscopic damage caused by the polymer clip on sympathetic nerve of rabbits seven days after their clipping and the findings after three weeks of clip removal.
Method: In this experimental study, 20 rabbits were divided into two groups of 10, group 1 (clipping) and group 2 (de-clipping). The right cervical sympathetic nerve of all animals was clamped with polymeric clip, and in group 2 the nerve was unclipped seven days later. Group 1 rabbits were induced to death on the 7th postoperative day, and group 2 on the 21st after removal of the polymer clip. Macroscopic variables were: clip appearance, presence of discontinuity lesion, infection and adhesions around the nerve. H&E was used in the evaluation of the phases and degree of the inflammatory process and presence of necrosis, and picrosirius red F3BA for quantification of collagen.
Results: The cervical sympathetic nerve was intact, without necrosis or infection in all animals of the experiment; there were adhesions in both groups, being minimal in eight animals of each group and moderate or intense in two; the clip was completely closed in all animals at the 7th postoperative day; the inflammatory process shown was chronic, with monomorphonuclear predominance. There was no significant difference between groups regarding the intensity the inflammatory process, but the amount of collagen type I and type III was significantly higher in group 2.
Conclusions: The injury caused by the polymer clip on the sympathetic nerve may be reversible, allowing functional return in the areas involved in the simulated cervical sympathectomy. Clipping of the cervical sympathetic nerve using a polymer clip does not cause discontinuity injury.
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Affiliation(s)
| | - Nicolau Gregori Czeczko
- Mackenzie Evangelical Faculty of Paraná, Curitiba, PR, Brazil.,University Evangelical Mackenzie Hospital, Curitiba, PR, Brazil
| | | | | | - Jurandir Marcondes Ribas-Filho
- Mackenzie Evangelical Faculty of Paraná, Curitiba, PR, Brazil.,University Evangelical Mackenzie Hospital, Curitiba, PR, Brazil
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Lee J, Jeong JY, Suh JH, Park CB, Kwoun H, Park SS. Thoracoscopic sympathetic block to predict compensatory hyperhidrosis in primary hyperhidrosis. J Thorac Dis 2021; 13:3509-3517. [PMID: 34277046 PMCID: PMC8264690 DOI: 10.21037/jtd-21-229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/29/2021] [Indexed: 11/13/2022]
Abstract
Background Compensatory hyperhidrosis is the main cause of patients’ dissatisfaction following sympathectomy for primary hyperhidrosis. Therefore, thoracoscopic sympathetic nerve block before sympathectomy can be used to predict compensatory hyperhidrosis after sympathectomy. The objective of this study is to review our recent experience with the nerve block procedure, describing efficacy, safety and validity. Methods We retrospectively reviewed the medical records of 107 patients who underwent thoracoscopic sympathetic nerve block with a local anesthetic for primary palmar and craniofacial hyperhidrosis using a 2-mm needlescope from March 2017 to November 2019. A week later, the patients were interviewed, and a decision made as to whether to proceed with sympathectomy. We analyzed the perioperative data of patients who underwent the predictive procedure either followed, or not followed, by sympathectomy. Results Primary hyperhidrosis was relieved in all patients by the predictive procedure without severe complications. Compensatory hyperhidrosis happened to 32 patients (29.9%). Seventy-eight patients (72.9%) decided to undergo sympathectomy (group A) and 29 patients (27.1%) refused the sympathectomy (group B). Group B tended to have higher average body mass index (24.5 versus 23.2 kg/m2, P=0.082) and compensatory hyperhidrosis rate after predictive procedure (37.9% versus 26.9%, P=0.269) compared to group A. The compensatory hyperhidrosis rate after sympathectomy in group A was 76.9%. The effective duration of sympathetic block was significantly longer in group A than in group B (33.5 versus 13.9 hours, P=0.001). The predictive procedure had 94.4% specificity and 33.3% sensitivity for prediction of compensatory hyperhidrosis. Conclusions Thoracoscopic sympathetic block may be safe and feasible as a procedure for predicting compensatory hyperhidrosis after sympathectomy, and beneficially, it allows the patients to experience the effect of sympathectomy on primary hyperhidrosis and occurrence of compensatory hyperhidrosis. However, a longer effective duration of sympathetic block is needed to help patients to decide whether to proceed with the surgery.
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Affiliation(s)
- June Lee
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Yong Jeong
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Hui Suh
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Beom Park
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hana Kwoun
- Department of Anesthesiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo Seog Park
- Department of Anesthesiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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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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Abu Arab WS, Elhamami MM. Plantar hyperhidrosis associated with primary palmar hyperhidrosis: Outcome following video-assisted thoracoscopic sympathectomy. Asian Cardiovasc Thorac Ann 2021; 29:310-317. [PMID: 33611949 DOI: 10.1177/0218492321996508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Primary palmar hyperhidrosis is an abnormal over-sweating of palms. It is usually associated with plantar hyperhidrosis. Video-assisted thoracoscopic sympathectomy is the treatment of choice for palmar hyperhidrosis; however, it may affect plantar hyperhidrosis. OBJECTIVES The aim of this study was to evaluate the effect of thoracoscopic sympathectomy on plantar hyperhidrosis. METHODS This prospective study included patients who presented to the Cardiothoracic Surgery Department with primary palmo-planter hyperhidrosis and received thoracoscopic sympathectomy between January 2014 and December 2018. Preoperatively, patients scored subjectively the degree of palmar and plantar hyperhidrosis on Visual Analogue Scale. Following surgery, scoring was performed at three intervals: 7, 30, and 180 days. Presence of compensatory sweating and its scoring was obtained at the same intervals. Complications and patient satisfaction were recorded. RESULTS A total of 518 patients were included. Complication rate, excluding compensatory hyperhidrosis, was 2.7%. Preoperative Visual Analogue Scale score for palmar hyperhidrosis was 9.9 ± 3.8 that following thoracoscopic sympathectomy decreased to 0.041 ± 0.2 on the seventh postoperative day. Further decrease to 0.3 ± 0.16 was noted on the 30th day and 180th day postoperatively. Preoperative Visual Analogue Scale score for plantar hyperhidrosis was 9.54 ± 0.66 that following sympathectomy decreased to 2.27 ± 1.67 on the seventh postoperative day. However, slight insignificant increase was noted to become 2.73 ± 1.65 on the 30th day and 6th month postoperatively. Compensatory hyperhidrosis was recorded in 3.9% of patients at 6th month postoperatively. CONCLUSION Palmar hyperhidrosis is usually associated with plantar hyperhidrosis. Thoracoscopic sympathectomy is an effective and safe treatment for palmar hyperhidrosis. It may completely or partially cure plantar hyperhidrosis.
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Affiliation(s)
- Walid Salah Abu Arab
- Cardiothoracic Surgery Department, Faculty of Medicine of Alexandria, Alexandria, Egypt
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Motus IY, Bazhenov AV. [Hyperhidrosis: treatment, results, problems]. Khirurgiia (Mosk) 2021:12-17. [PMID: 34270188 DOI: 10.17116/hirurgia202107112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To analyze the results of thoracic sympathectomy for hyperhidrosis. MATERIAL AND METHODS The study included 166 patients aged from 15-51 years. There were 118 women and 48 men. Isolated palmar hyperhidrosis was observed in 46 patients, axillary - 46 patients, palmar-axillary - 74 cases. Video-assisted thoracic bilateral sympathectomy was performed. In patients with palmar hyperhidrosis, sympathetic chain was transected between the ribs II and III, axillary and palmar-axillary hyperhidrosis - between the ribs III and IV. RESULTS Intraoperative injury of intercostal artery occurred in 1 case. Cautery was effective. Postoperative complications occurred in 4 (2.4%) patients (pneumothorax followed by drainage for up to 2-3 days). Symptoms of hyperhidrosis disappeared early after surgery in all cases. Long-term results were followed in 47 patients. Persistent positive effect and patient satisfaction with postoperative outcome were noted in 44 (93.6%) cases. Recurrences occurred in 2 patients with palmar hyperhidrosis and 1 patient with axillary hyperhidrosis for the period from 2 weeks to 6 months. Compensatory sweating developed in 26 (55.3%) patients (within several weeks up to 6 months). Mild compensatory sweating occurred in 17 patients, moderate - 8 patients, severe - 1 patient. Compensatory sweating was more common in patients with axillary and palmar-axillary hyperhidrosis compared to those with isolated palmar hyperhidrosis (p<0.05). We found no significant difference in the incidence of compensatory sweating depending on the level of sympathetic chain intersection (p>0.05). CONCLUSION An effectiveness of thoracic sympathectomy for hyperhidrosis is obvious. Compensatory sweating is the main undesirable consequence of this surgery. Prediction and prevention of compensatory sweating are not possible. It is imperative to warn the patient about possible compensatory sweating.
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Affiliation(s)
- I Ya Motus
- Ural Research Institute for Phthisiopulmonology, Ekaterinburg, Russia
- «Cosmetology and Plastic Surgery» LLC, Ekaterinburg, Russia
| | - A V Bazhenov
- Ural Research Institute for Phthisiopulmonology, Ekaterinburg, Russia
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Electrophysiological evaluation of efficacy of clipping in thoracic sympathectomy: An experimental cadaveric study. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:669-673. [PMID: 33403141 PMCID: PMC7759042 DOI: 10.5606/tgkdc.dergisi.2020.19412] [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: 01/27/2020] [Accepted: 03/03/2020] [Indexed: 11/25/2022]
Abstract
Background
This study aims to examine the efficacy of clipping in thoracic sympathectomy based on electrophysiological evaluation and to investigate whether nerve conduction can be formed by collateral nerve extensions as a result of the clipping procedure to different levels of sympathetic nerve.
Methods
Newly sacrificed six sheep hemithoraces were studied between August 2016 and October 2016. Thoracic sympathectomy was performed by clipping at T2, T3, T4, and T5 sympathetic chain levels and their branches. Electrophysiological studies were performed with an electromyography device and the filter range was 1 Hz with 20 μV/D amplification. Signals were processed digitally; bipolar subdermal needle electrodes were used as stimulation and recording electrodes (Ø 0.75 mm); and the ground electrode was placed in the intercostal muscle where the thoracic sympathectomy procedure would be performed.
Results
Electrophysiological evaluations showed that clips placed on the main sympathetic chain branches and sympathetic nerve trunk prevented collateral impulse conduction and stimulated potentials were not recorded. However, sympathetic conduction continued at the same intensity after removal of the clips.
Conclusion
Clipping of different regions of the sympathetic nerve provides electrophysiological blockage of the sympathetic nerve, and conduction continues after removal of the clips. However, the shortand long-term postoperative electrophysiological results after removal of the clips over the sympathetic nerve is still a question mark.
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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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Yeung C, Dawson J, Gilbert S. Uniportal video-assisted thoracoscopy approach to the management of non-pulmonary diseases of the chest. J Thorac Dis 2019; 11:S2062-S2068. [PMID: 31637039 DOI: 10.21037/jtd.2019.03.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The use of uniportal video-assisted thoracoscopy (u-VATS) is becoming a commonly used surgical technique and can be an effective approach for the surgical treatment of many pulmonary and non-pulmonary conditions. This review article summarizes current medical evidence informing the practice of u-VATS for treating non-pulmonary conditions including hyperhidrosis, hemothorax, pleural effusion, and thymic disease.
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Affiliation(s)
- Ching Yeung
- The Ottawa Hospital Research Institute, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada.,Faculty of Medicine, Department of Surgery, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada
| | - Jennifer Dawson
- The Ottawa Hospital Research Institute, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada
| | - Sebastien Gilbert
- The Ottawa Hospital Research Institute, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada.,Faculty of Medicine, Department of Surgery, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada
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Endoscopic thoracic sympathicotomy for primary palmar hyperhidrosis: A retrospective multicenter study in China. Surgery 2019; 166:1092-1098. [PMID: 31378477 DOI: 10.1016/j.surg.2019.05.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/05/2019] [Accepted: 05/27/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study aimed to evaluate the clinical efficacy and safety of endoscopic thoracic sympathicotomy and to explore strategies to decrease the incidence of transfer hyperhidrosis (TH). METHODS From January 2003 to July 2016, 10,275 patients with primary palmar hyperhidrosis underwent endoscopic thoracic sympathicotomy in 15 different institutions. We carried out a retrospective analysis of these patients who were grouped into group A, those with nonretained R2 (R2, R2-3, or R2-4 ablation), and group B, those with retained R2 (single R3 or R4 ablation). RESULTS All procedures were performed successfully. Both hands of all patients became warm and dry immediately after endoscopic thoracic sympathicotomy. Pneumothorax occurred in 146 patients, and 39 patients had intraoperative bleeding. Follow-up was carried out from 6 months to 13 years. A total of 531 patients (5.2%) were lost to follow-up. The effective rate for primary palmar hyperhidrosis was 100%. Palmar hyperhidrosis recurred in 73 patients (0.7%). Transfer hyperhidrosis appeared in 7,678 patients (78.8%). For groups A and B, the incidence of TH was 80.4% and 78.5%, respectively (P > .05), but the incidence of grade III+IV TH in group B (1.6%) was less than that in group A (4.8%; P < .001). CONCLUSION Endoscopic thoracic sympathicotomy is a minimally invasive, safe, and effective therapeutic method for primary palmar hyperhidrosis. Although the overall incidence of TH is high, the incidence of grade III to IV TH can be decreased by reserving R2, lowering the level of thoracic sympathicotomy, and single severing of R3 or R4.
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Kara M, Kose S, Ozkan B, Sertcakacilar G. Does clip removal help for compensatory hyperhidrosis complicating thoracic sympathetic clipping? Clin Auton Res 2019; 29:353-355. [PMID: 30859345 DOI: 10.1007/s10286-019-00599-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/26/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Murat Kara
- Istanbul University, Faculty of Medicine, Department of Thoracic Surgery, Istanbul, Turkey.
| | - Selcuk Kose
- Department of Thoracic Surgery, Bakirkoy Research and Training Hospital, Istanbul, Turkey
| | - Berker Ozkan
- Istanbul University, Faculty of Medicine, Department of Thoracic Surgery, Istanbul, Turkey
| | - Gokhan Sertcakacilar
- Department of Anesthesiology and Reanimation, Bakirkoy Research and Training Hospital, Istanbul, Turkey
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Hajjar WM, Al-Nassar SA, Al-Sharif HM, Al-Olayet DM, Al-Otiebi WS, Al-Huqayl AA, Hajjar AW. The quality of life and satisfaction rate of patients with upper limb hyperhidrosis before and after bilateral endoscopic thoracic sympathectomy. Saudi J Anaesth 2019; 13:16-22. [PMID: 30692883 PMCID: PMC6329233 DOI: 10.4103/sja.sja_335_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Hyperhidrosis is a functional disorder identified by excessive sweating. Its incidence is approximately 1% in any population. Bilateral endoscopic thoracic sympathectomy (BETS) intervention is the definitive treatment of choice for palmar and axillary hyperhidrosis. Aims and Objectives: The purpose of this study is to evaluate and compare the quality of life (QOL) and satisfaction rate of patients with upper limb hyperhidrosis before and after BETS surgery and the influence of compensatory hyperhidrosis (CH) on patients’ QOL after surgery. Settings and Design: This study is a cross-sectional study designed to generate longitudinal data. Subjects and Methods: This study is a cross-sectional study designed to generate longitudinal data pre- and postbilateral BETS prospectively. This study was conducted in the surgery department of University Hospital in Riyadh, Saudi Arabia. Hundred patients with upper limb hyperhidrosis who underwent BETS from 2014 to 2017 were included. A modified and validated QOL questionnaire for hyperhidrosis was completed by the patients themselves in order to compare the QOL for patients both before and after BETS. Patients’ satisfaction and the occurrence of CH were obtained postoperatively. Statistical Analysis Used: Data were analyzed using the SPSS® statistical package for social studies, version 22.0 (SPSS 22; IBM Corp., New York, NY, USA) for Windows®. Results: A total of 100 patients completed the questionnaire; 94% of patients had a positive QOL outcome after the surgery. The mean decrease in QOL scores was −42.0 points toward better QOL. The site of sweating had a significant effect on the patients’ QOL before and after the surgery (P value < 0.001). Moreover, 76% of patients reported a high satisfaction rate. Conclusion: Primary hyperhidrosis can negatively impair patients’ QOL in different domains. BETS showed to be an effective option for improving the QOL of patients and it provided both short- and long-term effectiveness in treating upper limb hyperhidrosis. CH did not interfere with the rate of patient satisfaction or their QOL postoperatively.
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Affiliation(s)
- Waseem M Hajjar
- Department of Surgery, Thoracic Surgery Division, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Sami A Al-Nassar
- Department of Surgery, Thoracic Surgery Division, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Heba M Al-Sharif
- Department of Surgery, Thoracic Surgery Division, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Dana M Al-Olayet
- Department of Surgery, Thoracic Surgery Division, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Wejdan S Al-Otiebi
- Department of Surgery, Thoracic Surgery Division, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Alanoud A Al-Huqayl
- Department of Surgery, Thoracic Surgery Division, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Adnan W Hajjar
- Department of Surgery, Thoracic Surgery Division, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
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Fibla Alfara JJ, Molins López-Rodó L, Hernández Ferrández J, Guirao Montes Á. Effectiveness of bilateral clipping of the thoracic sympathetic chain for the treatment of severe palmar and/or axillary hyperhidrosis and facial flushing. Cir Esp 2019; 97:196-202. [PMID: 30685056 DOI: 10.1016/j.ciresp.2018.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/14/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Division of the thoracic sympathetic chain is the standard treatment for severe palmar and/or axillary hyperhidrosis and facial flushing. Clipping is an alternative option which allows the block to be reverted in cases of intolerable compensatory sweating. METHODS This is a prospective study performed to assess: a) results of clipping of the thoracic sympathetic chain in patients with palmar and/or axillary hyperhidrosis and facial flushing; and b) to determine the improvement obtained after removal of the clip in patients with unbearable compensatory sweating. We included 299 patients (598 procedures) diagnosed with palmar hyperhidrosis (n=110), palmar and/or axillary hyperhidrosis (n=78), axillary hyperhidrosis (n=35), and facial flushing (n=76), who underwent videothoracoscopic clipping between 2007 and 2015. RESULTS 128 men and 171 women were treated, with mean age of 28 years. A total of 290 patients (97.0%) were discharged within 24hours. The procedure was effective in 92.3% (99.1% in palmar hyperhidrosis, 96,1% in palmar and/or axillary hyperhidrosis, 74.3% in axillary hyperhidrosis, and 86.8% in facial flushing). Nine patients (3%) presented minor complications. Compensatory sweating developed in 137 patients (45.8%): moderate in 113 (37.8%), severe in 16 (5.3%) and unbearable in 8 (2.7%). The clip was removed in these 8 patients; symptoms improved in 5 (62.8%), with sustained effect on hyperhidrosis in 4 of them. CONCLUSIONS Clipping of the thoracic sympathetic chain is an effective and safe procedure. If incapacitating compensatory sweating develops, this technique allows the clips to be removed with reversion of symptoms in a considerable number of patients.
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Affiliation(s)
| | - Laureano Molins López-Rodó
- Cirugía Torácica, Hospital Universitari Sagrat Cor, Barcelona, España; Cirugía Torácica, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | | | - Ángela Guirao Montes
- Cirugía Torácica, Hospital Universitari Sagrat Cor, Barcelona, España; Cirugía Torácica, Hospital Clínic, Universitat de Barcelona, Barcelona, España
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Du X, Zhu X, Wang T, Hu X, Lin P, Teng Y, Fan C, Li J, Xi Y, Xiao J, Liu W, Zhang J, Zhou H, Tian D, Yuan S. Compensatory hyperhidrosis after different surgeries at the same sympathetic levels: a meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:203. [PMID: 30023366 DOI: 10.21037/atm.2018.05.24] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Different techniques of video-assisted thoracoscopic sympathetic surgery have become the radical treatments for palmar and axillary hyperhidrosis (AH). However, there is no consensus over which technique can make a minimal incidence of compensatory hyperhidrosis (CH). This study was designed to compare the incidence of CH after different techniques at the same sympathetic levels in the treatment of upper limb and facial hyperhidrosis (FH). Methods The databases of PubMed, Web of Science, ScienceDirect, Ovid Medline, Embase, and Cochrane Library were searched to identify studies comparing different surgical techniques at the same sympathetic levels for upper limb and FH. The data was analyzed by Revman 5.3 software. Results A total of ten studies involving 896 patients were included, of whom 149 underwent sympathectomy, 435 underwent sympathicotomy, and 312 under endoscopic sympathetic clip (ESC). Meta-analysis showed that the difference of incidence of CH and patients' satisfaction was not significant between sympathectomy and sympathicotomy (P=0.05, 0.19, respectively). But, the incidence of CH is significant lower after ESC than after sympathicotomy (OR: 1.58, 95% CI: 1.04-2.38, P=0.03). However, the incidence of moderate/severe CH between these two groups is not significant different (OR: 1.49, 95% CI: 0.93-2.39, P=0.10). Conclusions If only CH and the same sympathetic levels concerned, sympathectomy and sympathicotomy is equal for upper limb hyperhidrosis and FH. And, ESC should be recommended for a lower incidence of CH, comparing with sympathicotomy.
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Affiliation(s)
- Xiaojun Du
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Xu Zhu
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Tao Wang
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Xiao Hu
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Peng Lin
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Yin Teng
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Chao Fan
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Jianglun Li
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Yang Xi
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Jiarong Xiao
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Wen Liu
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Jian Zhang
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Haiyu Zhou
- Department of Thoracic Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Dan Tian
- Department of Thoracic Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Shizhang Yuan
- Department of Thoracic Surgery, Guiyang Public Health Clinical Center, Guiyang 550003, China
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Musa AF, Gandhi VP, Dillon J, Nordin RB. A retrospective review on minimally invasive technique via endoscopic thoracic sympathectomy (ETS) in the treatment of severe primary hyperhidrosis: Experiences from the National Heart Institute, Malaysia. F1000Res 2018; 7:670. [PMID: 32724556 PMCID: PMC7338916 DOI: 10.12688/f1000research.14777.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Hyperhidrosis is due to the hyperactive autonomic stimulation of the sweat glands in response to stress. Primary hyperhidrosis is a common yet psychologically disabling condition. This study will describe our experience in managing hyperhidrosis via endoscopic thoracic sympathectomy (ETS). Methods: The information was obtained from the patient records from 1
st January 2011 until 31
st December 2016. Pertinent information was extracted and keyed into a study proforma. Results: 150 patients were operated on but only 118 patients were included in this study. The mean age was 22.9±7.3 years. The majority (54.2%) had palmar-plantar hyperhidrosis and 39.8% had associated axillary hyperhidrosis. Excision of the sympathetic nerve chain and ganglia were the main surgical technique with the majority (55.9%) at T2-T3 level. Mean ETS procedure time was 46.6±14.29 minutes with no conversion. Surgical complications were minimal and no Horner’s Syndrome reported. Mean hospital stay was 3.5±1.05 days. The majority of patients (67.8%) had only one follow-up and only half of the study sample (58.5%) complained mild to moderate degree of compensatory sweating, even though the long-term resolution is yet to be determined by another study. Following ETS, 98.3% of patients had instant relief and resolved their palmar hyperhidrosis. Predictors of CS were sympathectomy level and follow-up. The odds of reporting CS was 2.87 times in patients undergoing ETS at the T2-T3 level compared to those undergoing ETS at the T2-T4 level. The odds of reporting CS was 13.56 times in patients having more than one follow-up compared to those having only one follow-up. Conclusion: We conclude that ETS is a safe, effective and aesthetically remarkable procedure for the treatment of primary hyperhidrosis with only half of the patients developing mild to moderate degree of CS. Significant predictors of CS were sympathectomy level during ETS and frequency of follow-up after ETS.
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Affiliation(s)
- Ahmad Farouk Musa
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Vignaa Prashanth Gandhi
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Jeswant Dillon
- Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia
| | - Rusli Bin Nordin
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
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Effectiveness, success rates, and complications of different thoracoscopic sympathectomy techniques in patients with palmar hyperhidrosis. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:86-92. [PMID: 32082716 DOI: 10.5606/tgkdc.dergisi.2018.14686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/08/2017] [Indexed: 11/21/2022]
Abstract
Background This study aims to investigate the effectiveness, success and complication rates of three different video-assisted thoracoscopic sympathectomy procedures performed for the treatment of primary focal hyperhidrosis; excision, cauterization and clipping. Methods We retrospectively evaluated the records of 60 patients (33 males, 27 females; mean age 25.1±6.4 years; range 16 to 43 years) with primary focal hyperhidrosis and treated with videoassisted thoracoscopic sympathectomy between January 2010 and December 2013. The patients were treated bilaterally at the same session: the sympathetic chain and ganglia were excised from the spinal cord segments of T2-T4 in 20 patients (group 1), cauterized in 20 patients (group 2), and clipped in 20 patients (group 3). The procedural success and complication rates were compared among the groups. Results Sympathectomy was successfully performed in all patients. The mean operation time was found to be significantly shorter in group 2 (42.5±7.1 min) and group 3 (36.9±7.8 min), compared to group 1 (51.1±8.4 min) (p<0.05). Compensatory hyperhidrosis developed in 17 patients (28.3%) and was comparable among all groups (p<0.05). Conclusion Our study results suggest that excision, cauterization, and clipping are effective and reliable in the treatment of primary focal hyperhidrosis. Based on our experience, we believe that sympathectomy with video-assisted excision may be preferable for the treatment of primary focal hyperhidrosis.
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Fukuda JM, Varella AYM, Teivelis MP, de Campos JRM, Kauffman P, Pinheiro LL, Wolosker N. Video-Assisted Thoracoscopic Sympathectomy for Facial Hyperhidrosis: The Influence of the Main Site of Complaint. Ann Vasc Surg 2017; 46:337-344. [PMID: 28689957 DOI: 10.1016/j.avsg.2017.06.142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/13/2017] [Accepted: 06/20/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Facial hyperhidrosis (FH) may lead patients to a significantly impaired quality of life (QOL). Video-assisted thoracoscopic sympathectomy (VATS) is reserved for more severe cases refractory to common first-line agents. The aim of this study was to evaluate the efficacy of VATS for FH and to compare the results between patients with facial hyperhidrosis as main complaint (FHMC) and patients with facial hyperhidrosis as nonmain complaint (FHNMC). METHODS This was a retrospective study based on medical chart analysis from March 2000 to January 2014: 40 patients with FHMC and 136 patients with FHNMC. Patients underwent VATS at the T2, T3, or T4 level, according to the main site of complaint. We assessed improvement in QOL, improvement in hyperhidrosis, and presence of complications and side effects, notably compensatory hyperhidrosis (CH). RESULTS Patients with FHMC reported greater improvement in FH (97.1% versus 93.6%; P = 0.006) but had lower improvement in QOL (78.2% versus 92.7%; P = 0.024) compared to patients with FHNMC. For patients with FHNMC, any degree of improvement in FH was reported by 100%, almost 95%, and nearly 80% of the patients who underwent VATS at the T2, T3, and T4 level, respectively (P = 0.039). Pain and CH were reported by more than 61% and 92% of the patients, respectively, with no statistical difference between both groups. CONCLUSIONS Patients with FHMC, despite the greater improvement in FH, experienced lower improvement in QOL compared to patients with FHNMC. CH was the most frequent side effect in both groups, affecting more than 92% of the patients.
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Affiliation(s)
- Juliana Maria Fukuda
- Division of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil.
| | | | - Marcelo Passos Teivelis
- Division of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - José Ribas Milanez de Campos
- Division of Thoracic Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil; Division of Thoracic Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Paulo Kauffman
- Division of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil; Division of Vascular and Endovascular Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Lucas Lembrança Pinheiro
- Division of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Nelson Wolosker
- Division of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil; Division of Vascular and Endovascular Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Fiorelli A, Messina G, Chiodini P, Costanzo S, Viggiano A, Monda M, Vicidomini G, Santini M. Cardiac Autonomic Changes After Thoracic Sympathectomy: A Prospective, Randomized Study. Ann Thorac Surg 2017; 103:216-224. [DOI: 10.1016/j.athoracsur.2016.10.055] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 10/07/2016] [Accepted: 10/10/2016] [Indexed: 11/28/2022]
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Wolosker N, Milanez de Campos JR, Fukuda JM. Management of Compensatory Sweating After Sympathetic Surgery. Thorac Surg Clin 2016; 26:445-451. [DOI: 10.1016/j.thorsurg.2016.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Endoscopic thoracic sympathectomy (ETS) is an effective treatment of primary hyperhidrosis of the face, upper extremities, and axillae. The major limitation is the side effect of compensatory sweating severe enough that patients request reversal in up to 10% of cases. When ETS is performed by cutting the sympathetic chain, reversal requires nerve grafting. However, for ETS done with clips, reversal is a simple thoracoscopic outpatient procedure of removing the clips. Subsequent reversal of the sympathectomy, ie, nerve regeneration, is successful in many cases. However, follow-up is short. Factors contributing to success rates require further study.
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Bagheri R, Sharifian Attar A, Haghi SZ, Salehi M, Moradpoor R. Thoracoscopic sympathicotomy in the treatment of palmar hyperhidrosis. Asian Cardiovasc Thorac Ann 2016; 24:687-91. [DOI: 10.1177/0218492316657729] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Primary hyperhidrosis interferes with social activities and requires an effective and safe treatment. We aimed to compare the therapeutic outcomes of unilateral single-port sympathicotomy and open surgery. Methods Forty patients with primary palmar hyperhidrosis underwent sympathicotomy; 20 had open surgery, and 20 had video-assisted thoracic surgery. Complete resection of the T1 to T4 ganglia was performed by open surgery, and cutting and cauterization of the sympathetic chain between the T2 and T3 ganglia in the dominant hand was undertaken using video-assisted thoracic surgery. The patients were followed up at 1, 3, 6, and 12 months after surgery. Results The mean operative times were 39.6 ± 1.46 and 79.8 ± 1.53 min in the video-assisted thoracic surgery and open surgery group, respectively. The mean hospitalization was 2.2 ± 0.41 days after video-assisted thoracic surgery and 3.3 ± 0.47 days after open surgery. Complications included delayed hemothorax, compensatory hyperhidrosis, and wound infection. The mean blood loss during surgery and time to return to work were significantly less in the video-assisted thoracic surgery group. Excessive sweating was completely alleviated in the dominant hand in all patients, and in the opposite hand in 60% and 65% of the video-assisted thoracic surgery and open surgery group, respectively. Conclusion Single-port sympathicotomy between the T2 and T3 ganglia ipsilateral to the dominant hand is a safe, minimally invasive, and effective treatment for primary palmar hyperhidrosis. Alleviation of excessive sweating in the opposite hand can also be achieved in a large proportion of these patients.
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Affiliation(s)
- Reza Bagheri
- Cardiothoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Sharifian Attar
- Cardiothoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Ziaollah Haghi
- Cardiothoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Salehi
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Rosita Moradpoor
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Joo S, Lee GD, Haam S, Lee S. Comparisons of the clinical outcomes of thoracoscopic sympathetic surgery for palmar hyperhidrosis: R4 sympathicotomy versus R4 sympathetic clipping versus R3 sympathetic clipping. J Thorac Dis 2016; 8:934-41. [PMID: 27162669 DOI: 10.21037/jtd.2016.03.57] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Thoracoscopic sympathetic surgery is regarded as a definitive treatment for palmar hyperhidrosis. However, the optimal surgical strategy remains unclear. The aim of this study was to compare outcomes based on the level and type of sympathetic disconnection in patients with palmar hyperhidrosis. METHODS From January 2009 to December 2014, 101 patients with palmar hyperhidrosis underwent thoracoscopic sympathetic surgery at Gangnam Severance Hospital. Complete follow-up information was obtained from 59 patients. We retrospectively analyzed the results of operation, degree of palmar sweating (%), grade of compensatory sweating (none, mild, moderate, severe, very severe), grade of satisfaction (very satisfied, satisfied, moderate, dissatisfied, very dissatisfied), and recurrence/failure. RESULTS R4 sympathicotomy, R4 sympathetic clipping, and R3 sympathetic clipping were performed in 16, 20, and 23 patients, respectively. The mean degree of palmar sweating after sympathetic surgery was not significantly different between these three groups (17.50% vs. 27.00% vs. 29.78%; P=0.38). The rate of life-bothering compensatory sweating was lower in the R4 sympathicotomy group compared with those of other two groups (0% vs. 25%, 47.8%; P=0.09). The rate of very satisfied to moderate grades of satisfaction were lower in the R3 sympathetic clipping group compared with those of other two groups (93.8%, 100% vs. 73.9%; P=0.07). The rate of recurrence/failure rates were lower in the R4 sympathicotomy group compared with those of other two groups (12.50% vs. 35.00%, 34.8%; P=0.25). Sympathetic surgery at the R3 level was the only significant risk factor for patient dissatisfaction (odd ratio =12.353, 95% confidence interval =1.376-110.914; P=0.025). CONCLUSIONS Our data support that R4 sympathicotomy had lower grades of compensatory sweating, higher grades of satisfaction, and lower rates of recurrence/failure. We therefore consider R4 sympathicotomy as an optimal surgical treatment for palmar hyperhidrosis.
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Affiliation(s)
- Seok Joo
- 1 Department of Trauma Surgery, Regional Trauma Center, Gachon University Gil Hospital, Incheon, Republic of Korea ; 2 Department of Thoracic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Geun Dong Lee
- 1 Department of Trauma Surgery, Regional Trauma Center, Gachon University Gil Hospital, Incheon, Republic of Korea ; 2 Department of Thoracic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seokjin Haam
- 1 Department of Trauma Surgery, Regional Trauma Center, Gachon University Gil Hospital, Incheon, Republic of Korea ; 2 Department of Thoracic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungsoo Lee
- 1 Department of Trauma Surgery, Regional Trauma Center, Gachon University Gil Hospital, Incheon, Republic of Korea ; 2 Department of Thoracic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Up-to-date Treatments of Primary Hyperhidrosis with Focus on Sympathectomy and Sympathicotomy; A Narrative Review. HOSPITAL PRACTICES AND RESEARCH 2016. [DOI: 10.20286/hpr-01013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Zhu LH, Chen W, Chen L, Yang S, Lu ZT. Transumbilical thoracic sympathectomy: a single-centre experience of 148 cases with up to 4 years of follow-up†. Eur J Cardiothorac Surg 2015; 49 Suppl 1:i79-83. [PMID: 26553662 DOI: 10.1093/ejcts/ezv391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/08/2015] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Thoracic sympathectomy is considered as the most effective method to treat palmar hyperhidrosis (PH). Here, we report our experience of transumbilical thoracic sympathectomy with an ultrathin flexible endoscope for PH in a series of 148 patients with up to 4 years of follow-up. METHODS A prospective database was used in this retrospective analysis of 148 patients (61 males, 87 females, with a mean age of 21.3 years) with PH who were operated on by the same surgeon in a single institution from April 2010 to March 2014. All procedures were performed under general anaesthesia involving intubation with a double-lumen endotracheal tube. Demographic, postoperative and long-term data of patients were recorded and statistical analyses were performed. All patients were followed up at least 6 months post procedure through clinic visits or telephone/e-mail interviews. RESULTS The procedure was performed successfully in 148 of the 150 patients. Two patients had to be converted to conventional thoracoscopic procedure because of severe pleural adhesions. The mean operating time was 43 min (ranging from 39 to 107 min) and the mean postoperative length of stay was 1 day (range 1-4 days). All patients were interviewed 6-48 months after surgery and no diaphragmatic hernia or syndrome was observed. The rate of resolution of PH and axillary hyperhidrosis was 98 and 74.6%, respectively. Compensatory sweating was reported in 22.3% of patients. Almost all of the patients were satisfied with the surgical results and the cosmetic outcome of the incision. CONCLUSIONS This preliminary human experience suggested that transumbilical thoracic sympathectomy was a safe and efficacious alternative to the conventional approach. This technique avoided the chronic pain and chest wall paraesthesia that are associated with the chest incision. In addition, this novel procedure afforded maximum cosmetic benefits.
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Affiliation(s)
- Li-Huan Zhu
- Department of Thoracic Surgery, Jinan Military General Hospital, Shandong, China
| | - Weisheng Chen
- Department of Cardiothoracic Surgery, Fuzhou General Hospital of Fujian Medical University, Fuzhou, China
| | - Long Chen
- Department of Cardiothoracic Surgery, Fuzhou General Hospital of Fujian Medical University, Fuzhou, China
| | - Shengsheng Yang
- Department of Cardiothoracic Surgery, Fuzhou General Hospital of Fujian Medical University, Fuzhou, China
| | - Zhao-Tong Lu
- Department of Thoracic Surgery, Jinan Military General Hospital, Shandong, China
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Nicholas R, Quddus A, Baker DM. Treatment of Primary Craniofacial Hyperhidrosis: A Systematic Review. Am J Clin Dermatol 2015; 16:361-70. [PMID: 26055729 DOI: 10.1007/s40257-015-0136-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary craniofacial hyperhidrosis (CH) can have a profoundly negative impact on quality of life. No comprehensive review of its management exists. OBJECTIVE The objective of this review is to present the best clinical evidence to guide CH management. METHODS A systematic review was performed using PRISMA guidelines. MEDLINE and EMBASE were searched from 1966 to 2014 for articles using the MeSH terms "Hyperhidrosis", "Head", "Neck" and synonymous text words. Inclusion criteria were experimental and observational studies addressing CH treatment. Two reviewers independently assessed study quality and analysed data. RESULTS Of 833 references yielded, 27 met inclusion criteria and were analysed. Twenty-two studies evaluated T2 sympathetic ablation (Level III evidence). Outcome measures were subjective and mean follow-up was 29 months. Reported efficacy was high (70-100%), recurrence rates were generally low (0-8%) and complications largely transient (e.g. pneumothorax 0-1%). However, 8-95.4% experienced troubling compensatory sweating. One randomised controlled trial and one observational study evaluated botulinum toxin A (Level Ib and III, respectively). Both employed objective outcome measures and demonstrated similar findings. Efficacy was 100%, lasted a median of 5-6 months and frontalis muscle inhibition was the main adverse effect (50-100%). Three studies evaluated anticholinergic therapy: topical glycopyrrolate demonstrated high efficacy (96%) with minimal adverse effects (Level Ib) and oral oxybutynin demonstrated relatively high efficacy (80-100%) but with noticeable adverse effects (76.6-83.6%) (Level III). CONCLUSION There are few quality studies evaluating CH treatment. Based on available evidence, we recommend topical glycopyrrolate, oral oxybutynin and intradermal botulinum toxin A as first-line therapies due to their efficacy and safety. T2 sympathectomy should be considered for patients refractory to first-line therapy.
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Affiliation(s)
- Rebecca Nicholas
- Department of Surgery, Royal Free Hospital, Pond St, London, NW3 2QG, UK.
| | - Ayyaz Quddus
- Department of Surgery, Royal Free Hospital, Pond St, London, NW3 2QG, UK.
| | - Daryll M Baker
- Department of Surgery, Royal Free Hospital, Pond St, London, NW3 2QG, UK.
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Long-term results of a randomized controlled trial of T2 versus T2–T3 ablation in endoscopic thoracic sympathectomy for palmar hyperhidrosis. Surg Endosc 2015; 30:1219-25. [DOI: 10.1007/s00464-015-4335-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 06/05/2015] [Indexed: 10/23/2022]
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Hida K, Sakai T, Hayashi M, Tamagawa T, Abe Y. Sympathotomy for palmar hyperhidrosis: the cutting versus clamping methods. Clin Auton Res 2015; 25:271-6. [PMID: 25971626 DOI: 10.1007/s10286-015-0293-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 03/06/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Endoscopic thoracic sympathectomy/sympathotomy for the treatment of palmar hyperhidrosis is generally performed by either cutting or clamping the sympathetic chain. However, it remains unclear as to which of these methods is more effective and has fewer side effects. This study was conducted to compare the effects of sympathotomy by cutting or clamping at T3 on two outcomes--postoperative palmar sweating and compensatory sweating; it also evaluated postoperative patient satisfaction. METHODS The participants were among 289 patients who underwent bilateral sympathotomy at T3 for palmar hyperhidrosis. These patients were sent questionnaires by mail to assess their self-reported degree of postoperative palmar sweating and compensatory sweating, as well as their level of satisfaction. Of the 92 patients who responded to the questionnaire, 54 had undergone sympathotomy by cutting (cutting group) and 38 by clamping (clamping group). RESULTS The degree of postoperative palmar sweating was significantly lower in the cutting group than in the clamping group. However, compensatory sweating was significantly more severe in the cutting group than in the clamping group. No significant difference was observed in the degree of patient satisfaction between the groups. CONCLUSIONS Sympathotomy by clamping at T3 was less effective in reducing the primary symptom of postoperative palmar sweating, but induced less compensatory sweating than did sympathotomy by cutting at T3. However, both methods were similar with regard to patient satisfaction. The degree of postoperative palmar sweating and the severity of compensatory sweating were inversely correlated with the degree of patient satisfaction.
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Affiliation(s)
- Kumiko Hida
- Pain Clinic, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Tetsuya Sakai
- Department of Anesthesiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Maya Hayashi
- Pain Clinic, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Takao Tamagawa
- Pain Clinic, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Yoichiro Abe
- Pain Clinic, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
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Prise en charge d’une hyperhidrose. Ann Dermatol Venereol 2015; 142:252-61. [DOI: 10.1016/j.annder.2014.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 10/03/2014] [Accepted: 11/07/2014] [Indexed: 11/22/2022]
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Reversal of Sympathetic Interruption by Removal of Clips. Ann Thorac Surg 2015; 99:1020-3. [DOI: 10.1016/j.athoracsur.2014.10.062] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 10/17/2014] [Accepted: 10/31/2014] [Indexed: 12/18/2022]
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Surgical Cardiac Denervation Therapy for Treatment of Congenital Ion Channelopathies in Pediatric Patients. World J Pediatr Congenit Heart Surg 2014; 6:33-8. [DOI: 10.1177/2150135114555203] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Congenital ion channel disorders, including congenital long QT syndrome (LQTS), cause significant morbidity in pediatric patients. When medication therapy does not control symptoms or arrhythmias, more invasive treatment strategies may be necessary. This study examines our institution’s clinical experience with surgical cardiac denervation therapy for management of these arrhythmogenic disorders in children. Methods: An institutional review board–approved retrospective review identified ten pediatric patients with congenital ion channelopathies who underwent surgical cardiac denervation therapy at a single institution between May 2011 and April 2014. Eight patients had a diagnosis of congenital LQTS, two patients were diagnosed with catecholaminergic polymorphic ventricular tachycardia (CPVT). All patients underwent sympathectomy and partial stellate ganglionectomy via video-assisted thoracoscopic surgery (VATS). Results: Six of the ten patients had documented ventricular arrhythmias preoperatively, and 70% of the patients had preoperative syncope. The corrected QT interval decreased in 75% of patients with LQTS following sympathectomy. Postoperative arrhythmogenic symptoms were absent in 88% of congenital LQTS patients, but both patients with CPVT continued to have symptoms throughout the duration of follow-up. All patients were alive after a median follow-up period of 10 months. Conclusions: Surgical cardiac denervation therapy via VATS is a useful treatment strategy for congenital LQTS patients who fail medical management, and its potential benefit in the management of CPVT is unclear. A prospective comparison of the efficacy of surgical cardiac denervation therapy and implantable cardioverter-defibrillator use in congenital ion channelopathies is timely and crucial.
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Panhofer P, Ringhofer C, Gleiss A, Jakesz R, Prager M, Bischof G, Neumayer C. Quality of life after sympathetic surgery at the T4 ganglion for primary hyperhidrosis: clip application versus diathermic cut. Int J Surg 2014; 12:1478-83. [PMID: 25463770 DOI: 10.1016/j.ijsu.2014.11.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 11/12/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Limited procedures at the T4 ganglion show low rates of compensatory sweating (CS). The aim of the study was to compare endoscopic sympathetic block (ESB) via clip application with endothoracic sympathicotomy (ETS) via diathermy with special regard on patients' quality of life (Qol). PATIENTS AND METHODS Treatment success, side effects and patient satisfaction were evaluated in a prospectively gathered database of a tertiary-care referral hospital. Two disease-specific Qol questionnaires were used (Keller, Milanez de Campos). RESULTS 406 operations were performed in 205 patients (ESB4 N = 114, ETS4 N = 91) with a median follow-up of 12 months. Both procedures improved Qol significantly (P < 0.001) and the degree of improvement was equal in both groups. Palmar and axillary HH were ameliorated after both procedures (P < 0.001). Accordingly, plantar HH decreased after ESB4 (P = 0.002), while remaining unaltered after ETS4. Nineteen patients (9.3%) reported CS and 10 patients (4.9%) judged it as "disturbing". Nine of the latter belonged to the ETS4 group compared to one ESB patient (P = 0.015). Patients developed higher rates of plantar CS after ETS4 compared to ESB4 (P = 0.006). Five patients (2.4%) from both cohorts reported persistence of axillary HH. Recurrence of axillary symptoms was found in 5 ESB4 patients. Satisfaction rates did not differ significantly. CONCLUSION Patients' Qol and satisfaction rates are similar in both treatment groups for upper limb HH. Outcome and recurrence rates speak in the favor of ETS4, severity of CS and potential reversibility argue for ESB4.
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Affiliation(s)
- Peter Panhofer
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Austria.
| | - Claudia Ringhofer
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Austria
| | - Andreas Gleiss
- Institute for Clinical Biometrics, Center for Medical Statistics, Informatics, and Intelligent, Systems, Medical University of Vienna, Austria
| | - Raimund Jakesz
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Austria
| | | | - Georg Bischof
- Department of Surgery, St. Josef Hospital, Vienna, Austria
| | - Christoph Neumayer
- Division of Vascular Surgery, Department of Surgery, Medical University of Vienna, Austria
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Teivelis MP, Wolosker N, Krutman M, Milanez de Campos JR, Kauffman P, Puech-Leão P. Compensatory Hyperhidrosis: Results of Pharmacologic Treatment With Oxybutynin. Ann Thorac Surg 2014; 98:1797-802. [DOI: 10.1016/j.athoracsur.2014.05.087] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 05/24/2014] [Accepted: 05/28/2014] [Indexed: 11/24/2022]
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Glaser DA, Galperin TA. Botulinum Toxin for Hyperhidrosis of Areas Other than the Axillae and Palms/Soles. Dermatol Clin 2014; 32:517-25. [DOI: 10.1016/j.det.2014.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kocher GJ, Taha A, Ahler M, Schmid RA. Is clipping the preferable technique to perform sympathicotomy? A retrospective study and review of the literature. Langenbecks Arch Surg 2014; 400:107-12. [DOI: 10.1007/s00423-014-1249-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022]
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Thomsen LL, Mikkelsen RT, Derejko M, Schrøder HD, Licht PB. Sympathetic block by metal clips may be a reversible operation. Interact Cardiovasc Thorac Surg 2014; 19:908-13. [PMID: 25228245 DOI: 10.1093/icvts/ivu311] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Thoracoscopic sympathectomy is now used routinely to treat patients with disabling primary hyperhidrosis or facial blushing. Published results are excellent, but side effects, such as compensatory sweating, are also very frequent. The surgical techniques used and the levels of targeting the sympathetic chain vary tremendously. Most surgeons transect or resect the sympathetic chain, but application of a metal clip that blocks transmission of nerve impulses in the sympathetic chain is used increasingly worldwide. This approach offers potential reversibility if patients regret surgery, but the question of reversibility remains controversial. Two recent experimental studies found severe histological signs of nerve damage 4-6 weeks after clip removal, but they only used conventional histopathological staining methods. METHODS Thoracoscopic clipping of the sympathetic trunk was performed in adult sheep, and the clip was removed thoracoscopically after 7 days. Following another 4 weeks (n = 6) or 12 weeks (n = 3), the sympathetic trunks were harvested and analysed by conventional and specific nerve tissue immunohistochemical stains (S100, neurofilament protein and synaptophysin). The contralateral sympathetic chains were used as controls. RESULTS Conventional and immunohistochemical stains demonstrated severe signs of neural damage on the operated side 4 weeks after clip removal. After 12 weeks, these changes had decreased markedly and conventional histology had almost normalized. CONCLUSIONS Conventional and immunohistochemical stains confirmed that application of metal clips to the sympathetic chain caused severe histological damage in the sympathetic trunk that remained visible 4 weeks after clip removal. However, after 12 weeks, these signs of damage had clearly decreased, which suggests in theory that application of metal clips to the sympathetic chain is a reversible procedure if only the observation period is prolonged. Further studies with longer periods between application and removal as well as investigations of nerve conduction should be encouraged, because we do not know whether histological reversibility at cellular level translates into physiological reversibility and possible correlation of nerve trauma with the duration of the applied clip.
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Affiliation(s)
- Lars L Thomsen
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Rasmus T Mikkelsen
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Miroslawa Derejko
- Department of Neurophysiology, Odense University Hospital, Odense, Denmark
| | - Henrik D Schrøder
- Department of Clinical Pathology, Odense University Hospital, Odense, Denmark
| | - Peter B Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
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Paliogiannis P, Marrosu A, Attene F, Trignano M, Scognamillo F. An unusual case of excessive sweating affecting the right upper limb after bilateral endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: recurrence or compensatory hyperhidrosis? Eur Surg 2014. [DOI: 10.1007/s10353-014-0275-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Effect of lowering or restricting sympathectomy levels on compensatory sweating. Clin Auton Res 2014; 24:143-9. [PMID: 24740713 DOI: 10.1007/s10286-014-0242-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE There is controversy on whether lowering or restricting the level of sympathectomy can reduce compensatory sweating (CS). This study compared the results from sympathectomies performed to treat severe palmar hyperhidrosis using two distinct levels of T2-4 and T3-4. METHODS One hundred and sixteen patients with primary palmar hyperhidrosis were randomly allocated to undergo either T2-4 sympathectomy treatment (T2-4 group) or T3-4 sympathectomy treatment (T3-4 group). Follow-up data were collected using a telephone questionnaire to assess efficacy, side effects, overall satisfaction, and factors affecting CS and the degree of satisfaction. RESULTS There were no significant differences with respect to either CS or severe CS between the two treatment groups at 1, 6, or 12 months of follow-up. The total scores of the quality-of-life questionnaires after surgery were remarkably decreased compared with those before surgery in the two groups. However, no significant differences in quality-of-life scores were found between the two groups before surgery, or at 1, 6, or 12 months of follow-up. Age was predictive of severe CS at 6 months of follow-up (P = 0.045). Severe CS was inversely associated with patient satisfaction at 1, 6, and 12 months of follow-up. INTERPRETATION The issue of whether lowering or restricting the level of sympathectomy reduces CS is controversial and needs more supportive evidence. Age may be a predictive factor for severe CS at 6 and 12 months of follow-up. Severe CS is the only known factor that affects patient satisfaction, and family history may also be associated with patient satisfaction.
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Bryant AS, Cerfolio RJ. Satisfaction and compensatory hyperhidrosis rates 5 years and longer after video-assisted thoracoscopic sympathotomy for hyperhidrosis. J Thorac Cardiovasc Surg 2014; 147:1160-1163.e1. [DOI: 10.1016/j.jtcvs.2013.12.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 11/26/2013] [Accepted: 12/09/2013] [Indexed: 11/28/2022]
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One-year follow-up period after transumbilical thoracic sympathectomy for hyperhidrosis: Outcomes and consequences. J Thorac Cardiovasc Surg 2014; 147:25-8. [DOI: 10.1016/j.jtcvs.2013.08.062] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 07/17/2013] [Accepted: 08/27/2013] [Indexed: 11/19/2022]
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Panhofer P, Gleiss A, Eilenberg WH, Jakesz R, Bischof G, Neumayer C. Long-term outcomes after endothoracic sympathetic block at the T4 ganglion for upper limb hyperhidrosis. Br J Surg 2013; 100:1471-7. [PMID: 24037567 DOI: 10.1002/bjs.9275] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aim of this study was to evaluate long-term results, quality of life, satisfaction and compensatory sweating after endothoracic sympathetic block at T4 (ESB4). METHODS Patients who underwent an ESB4 procedure for palmar or palmoaxillary hyperhidrosis between 2001 and 2008 were included in a prospective study at a university hospital. Questionnaires devised by Keller and Milanez de Campos were applied to evaluate disease-specific quality of life. RESULTS A total of 189 patients underwent 374 ESB4 procedures. Of 174 evaluated patients, 54 (31·0 per cent) had palmar and 120 (69·0 per cent) had palmoaxillary hyperhidrosis. Median follow-up was 92 months. In both groups, treatment successfully reduced hyperhidrosis (P < 0·001) and quality of life increased significantly after ESB4 (P < 0·001), remaining stable after 5 years. Overall satisfaction rates decreased owing to the development of compensatory sweating and recurrence during follow-up. Compensatory sweating affected 41 patients (23·6 per cent), and was severe in 11 (6·7 per cent) of 163 patients at 5-year follow-up; eight of these 11 patients had been treated for palmoaxillary sweating. The severity of compensatory sweating did not deteriorate with time. The severe recurrence rate increased to 11·0 per cent during follow-up, and was twice as common in patients treated for palmoaxillary sweating as in those treated for palmar sweating (13·2 versus 6·1 per cent respectively). Nine reoperations (5·2 per cent) were performed for persistent sweating, recurrence or compensatory sweating. CONCLUSION T4 endothoracic sympathetic clip application is safe and effective in patients with upper limb hyperhidrosis, with stable long-term improvements in quality of life.
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Affiliation(s)
- P Panhofer
- Departments of General Surgery, University Clinic of Surgery, Medical University of Vienna, Vienna, Austria
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Zhu LH, Chen L, Yang S, Liu D, Zhang J, Cheng X, Chen W. Embryonic NOTES thoracic sympathectomy for palmar hyperhidrosis: results of a novel technique and comparison with the conventional VATS procedure. Surg Endosc 2013; 27:4124-9. [DOI: 10.1007/s00464-013-3079-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 06/17/2013] [Indexed: 10/26/2022]
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Long-term results of endoscopic sympathetic block using the Lin-Telaranta classification. Surg Endosc 2013; 27:3860-4. [PMID: 23708713 DOI: 10.1007/s00464-013-2995-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Endoscopic thoracic sympathectomy has been used successfully in the treatment of blushing, excessive sweating, and social phobia. However, the adverse effects of endoscopic thoracic sympathectomy are more severe and frequent than the adverse effects of endoscopic sympathetic block (ESB). The use of different blocking levels for different indications in ESB according to the Lin-Telaranta classification further decreases the postoperative adverse effects. However, there are few data on the long-term results of ESB performed using the Lin-Telaranta classification. METHODS Ninety-five patients (55 men, 40 women) were interviewed by before the surgery using our routine questionnaire, and the same questionnaire was answered postoperatively by the patients. In addition, a long-term follow-up questionnaire was sent to all patients whose address was known. Forty-seven patients (24 men, 23 women) answered to this questionnaire. The Davidson brief social phobia scale and the Liebowitz quality of life scale were used. Patients were divided to 3 categories: category 1, patients with sweating problems; category 2, patients with blushing; and category 3, and patients with symptoms other than sweating or blushing. RESULTS Among patients in category 1, social phobia decreased from 12.43 to 6.71 (p = 0.004), in category 2 from 13.97 to 7.69 (p < 0.001), and in category 3 from 13.18 to 9.64 (p = 0.007) during long-term follow-up. Among patients with severe sweating problems preoperatively, sweating decreased from 2.50 to 1.29 (p = 0.003) among patients in category 1 and from 1.86 to 1.16 (p < 0.001) among patients in category 2. Among patients with unbearable blushing, blushing decreased from 4 to 1.80 (p < 0.001). CONCLUSIONS Patients got a clear help from ESB performed using the Lin-Telaranta classification to treat blushing, excessive sweating, and social phobia with and without physical symptoms. In addition, compensatory sweating increased only slightly.
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Zhu LH, Wang W, Yang S, Li D, Zhang Z, Chen S, Cheng X, Chen L, Chen W. Transumbilical thoracic sympathectomy with an ultrathin flexible endoscope in a series of 38 patients. Surg Endosc 2013; 27:2149-55. [DOI: 10.1007/s00464-012-2732-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 12/04/2012] [Indexed: 10/27/2022]
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