1
|
Chen LWY, Chang TNJ, Lee CP, Sung CWH, Cheng C, Chang KH, Chao YK. Robotic sympathetic trunk reconstruction for compensatory sweating after thoracic sympathectomy. JTCVS Tech 2023; 21:251-258. [PMID: 37854845 PMCID: PMC10579868 DOI: 10.1016/j.xjtc.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 10/20/2023] Open
Abstract
Objectives Endoscopic thoracic sympathectomy may be complicated by the onset of disabling compensatory sweating (CS). The objective of this case series is to report the 2-year outcomes after robotic sympathetic trunk reconstruction (STR) for the reversal of CS in patients who had undergone endoscopic thoracic sympathectomy. Methods We prospectively followed-up a total of 23 patients who had undergone robotic STR because of intolerable CS between October 2017 and January 2021. A visual analog scale ranging from 0 to 10 (with 10 indicating the highest degree) was used to assess the severity of CS at different anatomical locations, thermoregulatory alterations, and gustatory hyperhidrosis. Measurements were performed before STR and at 6-month and 2-year follow-up. Results The mean age of the study participants was 43.3 ± 7.8 years, and 20 (87%) were men. The reversal procedure was performed after a mean of 19.6 ± 7.8 years from endoscopic thoracic sympathectomy. In all patients, nerve defects were successfully bridged using sural nerves (mean length, 9.7 cm on the right and 9.8 cm on the left). No cases of Horner syndrome were noted. At 6 postoperative months, the severity of CS decreased significantly at all body surface areas. The observed improvements were effectively maintained at 24 post-STR months. There was no evidence of either recurrent hyperhidrosis at the primary site or transition of CS to other anatomical locations. Similar improvements were evident for thermoregulatory alterations and gustatory hyperhidrosis. Conclusions Robotic STR is safe and effective in reversing intolerable CS after endoscopic thoracic sympathectomy.
Collapse
Affiliation(s)
- Lisa Wen-Yu Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tommy Nai-Jen Chang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chin-Pang Lee
- Department of Psychiatry, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Cheyenne Wei-Hsuan Sung
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chuan Cheng
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Hsuan Chang
- Department of Neurology, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
2
|
Wang L, Wu X, Tang Y, Fan Z. Postoperative diaphragmatic hernia following endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: A case report. Front Surg 2023; 9:1059604. [PMID: 36684120 PMCID: PMC9852327 DOI: 10.3389/fsurg.2022.1059604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/10/2022] [Indexed: 01/08/2023] Open
Abstract
Postoperative diaphragmatic hernia (DH) following endoscopic thoracic sympathectomy for primary palmar hyperhidrosis is extremely rare. We present a 21-year-old female patient who developed a left DH with herniation of the stomach and gastric perforation on the first postoperative day after undergoing bilateral video-assisted thoracoscopic sympathectomy R4 ablation. She complained of severe dyspnea and chest pain, and an emergency chest x-ray and computed tomography revealed left pleural effusion, collapsed lung, and left DH, which allowed the stomach to herniate into the chest. Emergency thoracoscopic surgery was performed. We repaired the diaphragmatic defect intraoperatively and replaced the stomach with the peritoneal cavity from the thoracic field. The patient was discharged without complications. She did not present with recurrent symptoms at the 3-month follow-up. Postoperative DH should be considered when patients complain of gastrointestinal or respiratory symptoms after sympathectomy, although it is very rare.
Collapse
Affiliation(s)
- Ling Wang
- Department of Emergency Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xike Wu
- Department of Cardiothoracic Surgery, The Affiliated Jinyang Hospital of Guizhou Medical University, Guiyang, China
| | - Yuepu Tang
- Department of Cardiothoracic Surgery, The Affiliated Jinyang Hospital of Guizhou Medical University, Guiyang, China
| | - Zheyuan Fan
- Department of Cardiothoracic Surgery, The Affiliated Jinyang Hospital of Guizhou Medical University, Guiyang, China,Correspondence: Zheyuan Fan
| |
Collapse
|
3
|
Soares TJ, Dias PG, Sampaio SM. Impact of Video-Assisted Thoracoscopic Sympathectomy and Related Complications on Quality of Life According to the Level of Sympathectomy. Ann Vasc Surg 2019; 63:63-67.e1. [PMID: 31629129 DOI: 10.1016/j.avsg.2019.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/07/2019] [Accepted: 07/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Primary hyperhidrosis is defined as excessive sweating of idiopathic etiology, associated with sympathetic hyperactivity, which greatly impacts patients' quality of life (QoL). The definitive treatment for palmar and axillary hyperhidrosis (PAH) is video-assisted thoracic sympathectomy (VATS). The objective of this study was to evaluate the quality of life of patients with PAH before and after VATS according to the level of sympathectomy performed, as well as the presence of compensatory hyperhidrosis (CH) and other complications. METHODS All patients who underwent VATS in our vascular surgery department between January 2011 and December 2016 were included in the analysis. From 120 contact attempts, 88 interviews were carried out. Patients were divided into 2 groups according to the intervened thoracic level: high thoracic ganglion (HTG; T2, T2-T3, T2-T3-T4; n = 68) and low thoracic ganglion (LTG; T3, T3-T4, T4; n = 20). The questionnaire evaluated preoperative PAH severity, the presence of CH, preoperative and postoperative QoL, and postoperative satisfaction. RESULTS The median age of patients was 29 years, and the median follow-up period was 32 months (IQR of 34 months). Most patients had severe or very severe PAH (97.7%) and preoperative QoL was bad or very bad (95.5%). Postoperatively, QoL was significantly improved in all domains evaluated, with no differences observed between the groups. The overall percentage of complications was 11.4%, mostly pneumothorax, but there was a significantly lower incidence of complications in the HTG group (P = 0.029). Compensatory hyperhidrosis developed in 85.2% of cases, but it was only considered intolerable in 10.2%. The incidence of CH was 82.4% in the HTG group and 95% in the LTG group, with no statistically significant differences between the groups (P = 0.147). CONCLUSIONS Palmar and axillary hyperhidrosis severely affects QoL, and video-assisted thoracic sympathectomy was proven to be effective regardless of the target ganglion resected. Although CH was frequent, it was tolerated in most cases.
Collapse
Affiliation(s)
- Tiago J Soares
- Angiology and Vascular Surgery Unit, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal.
| | - Paulo G Dias
- Angiology and Vascular Surgery Unit, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Sérgio M Sampaio
- Angiology and Vascular Surgery Unit, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| |
Collapse
|
4
|
Right chylothorax after thoracic sympathicotomy: A very rare case. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:484-486. [PMID: 32082785 DOI: 10.5606/tgkdc.dergisi.2018.15313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/11/2017] [Indexed: 11/21/2022]
Abstract
Today, the most common indication for thoracic sympathectomy/ sympathicotomy is primary focal hyperhidrosis. The operation is performed thoracoscopically and usually the approach to the sympathetic chain is conducted through the third and fourth ribs. Although it is performed as a minimally invasive procedure with high success rates, there are also some common complications. In this article, we present a very rare case developing right chylothorax after right thoracic sympathicotomy.
Collapse
|
5
|
Lin ML, Huang TR, Kao MC, Chiu HW, Lin SC, Chang FC. Pulsed radiofrequency stimulation suppresses palmar hyperhidrosis in an animal study. Brain Behav 2017; 7:e00833. [PMID: 29201541 PMCID: PMC5698858 DOI: 10.1002/brb3.833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/08/2017] [Accepted: 08/28/2017] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Palmar hyperhidrosis (PH) exhibits excessive and unpredictable sweating. The most effective treatment for permanent cure is the ablation of thoracic sympathetic ganglia innervating hands. However, sympathectomy of T2 sympathetic ganglion by clipping or cauterization causes irreversible nerve damage, and results in a compensatory hyperhidrosis (CH). We herein used the pulsed radiofrequency (PRF) stimulation to reversibly block sympathetic ganglion to treat PH and avoid CH. MATERIAL AND METHODS A bipolar electrode was implanted into the right T2 sympathetic trunk by endoscopic surgery and PRF was delivered through the electrode. The humidity (%) of right palm was measured to indicate sweating level. RESULTS Six out of 13 rats (46.2%) that received a 5-min PRF stimulation on the T2 sympathetic trunk showed a decrease in the right palm humidity during the surgery. PRF stimulation significantly reduced humidity from 69.17% ± 0.72% obtained from baseline condition to 66.93% ± 0.69%. The humidity reduction was also observed at 10 min after the PRF stimulation. We further evaluated the effect of PRF stimulation 1 week after surgery and found that the PRF stimuli reduced right hand humidity in 5 out of 8 rats (62.5%). PRF stimulation significantly reduced humidity from 66.11% ± 0.81% obtained from sham operation control to 63.62% ± 0.82%. The percentage of right hand humidity obtained 10 min after PRF stimulation was also reduced to 63.38% ± 0.80%. Anesthetics have no effect on humidity. CONCLUSIONS These results indicate that PRF stimulation of T2 sympathetic trunk reduces palm sweating in rats.
Collapse
Affiliation(s)
- Mu-Lien Lin
- Department of Anesthesiology Medical School National Yang-Ming University Taipei Taiwan.,Pain Clinic Taipei City Hospital Taipei Taiwan
| | - Tzu-Rung Huang
- Department of Veterinary Medicine School of Veterinary Medicine National Taiwan University Taipei Taiwan
| | - Ming-Chien Kao
- Department of Surgery College of Medicine National Taiwan University Taipei Taiwan.,Department of Surgery National Cheng-Kung University Tainan Taiwan
| | - Hung-Wei Chiu
- Department of Electronic Engineering National Taipei University of Technology Taipei Taiwan
| | - Sheng-Chieh Lin
- Department of Surgery National Taiwan University Hospital Taipei Taiwan
| | - Fang-Chia Chang
- Department of Veterinary Medicine School of Veterinary Medicine National Taiwan University Taipei Taiwan.,Graduate Institute of Brain & Mind Sciences College of Medicine National Taiwan University Taipei Taiwan.,Graduate Institute of Acupuncture Science College of Chinese Medicine China Medical University Taichung Taiwan
| |
Collapse
|
6
|
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.
Collapse
|
7
|
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]
|
8
|
Lecouflet M, Leux C, Fenot M, Célerier P, Maillard H. Duration of efficacy increases with the repetition of botulinum toxin A injections in primary palmar hyperhidrosis: A study of 28 patients. J Am Acad Dermatol 2014; 70:1083-7. [DOI: 10.1016/j.jaad.2013.12.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/19/2013] [Accepted: 12/20/2013] [Indexed: 10/25/2022]
|
9
|
Lecouflet M, Leux C, Fenot M, Célerier P, Maillard H. Duration of efficacy increases with the repetition of botulinum toxin A injections in primary axillary hyperhidrosis: a study in 83 patients. J Am Acad Dermatol 2013; 69:960-4. [PMID: 24035554 DOI: 10.1016/j.jaad.2013.08.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 07/30/2013] [Accepted: 08/02/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intradermal injections of botulinum toxin are effective but transitory in primary axillary hyperhidrosis. These injections are repeated when the symptoms recur. The reported duration of efficacy is variable, from 2 to 24 months, but it is unknown how the duration of efficacy changes when injections are repeated. OBJECTIVE In this retrospective study, we aimed to evaluate changes in the duration of efficacy of botulinum toxin injections (Dysport, Ipsen, Boulogne-Billancourt, France) with the repetition of injections in patients with axillary hyperhidrosis. METHODS From May 2001 to April 2012 inclusive, 83 patients were treated with a dose of 125 U per underarm. We compared the duration of effect of the first and last toxin injections. RESULTS The median duration of efficacy for the first injection was 5.5 months, whereas that for the last injection was 8.5 months. The difference between these 2 durations is statistically significant (P = .0002). LIMITATIONS Although retrospective and based on the declarative, this work is the first to our knowledge to highlight this benefit of treatment and to evaluate botulinum toxin over such a long period (11 years). CONCLUSION There appears to be an increase in the duration of efficacy of botulinum toxin A injections with the repetition of injections in patients with primary axillary hyperhidrosis. The reasons for this effect may be linked to the mechanism of action of botulinum toxin, and may improve our understanding of its pharmacologic effects.
Collapse
Affiliation(s)
- Marie Lecouflet
- Department of Dermatology, Le Mans Hospital, Le Mans, France.
| | | | | | | | | |
Collapse
|
10
|
Öncel M. Bilateral thoracoscopic sympathectomy for primary hyperhydrosis: a review of 335 cases. Cardiovasc J Afr 2013; 24:137-40. [PMID: 24217046 PMCID: PMC3734871 DOI: 10.5830/cvja-2013-007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 01/24/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The goal of this retrospective study was to evaluate the outcomes of bilateral video-assisted thoracoscopic sympathectomy for primary hyperhydrosis. METHODS Between January 2007 and December 2011, a total of 335 patients (192 male, 143 female, mean age 28.3 years) who underwent bilateral thoracoscopic sympathectomy for primary hyperhydrosis were reviewed retrospectively. RESULTS Hyperhydrosis occurred in the palmar and axillary region in 175 (52.23%) patients, in only the palmar region in 52 (15.52%), in the craniofacial region in 44 (13.13%), in only the axillary region in 42 (12.53%), and in the palmar and pedal regions in 22 (6.56%) patients. Bilateral thoracoscopic sympathectomy was performed in all patients. The mean follow-up period was 24 (6-48) months. The initial cure rate was 95% and the initial satisfaction rate was 93%. There was no mortality in this study. The complication rate was 15.82% in 53 patients. CONCLUSION Video-assisted thoracoscopic sympathectomy for the treatment of primary hyperhydrosis was effective, with low rates of morbidity and mortality. Despite the appearance of postoperative complications, such as compensatory sweating, patient satisfaction with the procedure was high and their quality of life improved.
Collapse
Affiliation(s)
- Murat Öncel
- Department of Thoracic Surgery, Selcuklu Medicine Faculty, Selcuk University, Konya, Turkey
| |
Collapse
|
11
|
Knudsen MR, Nyboe C, Hjortdal VE, Pilegaard HK. Routine postoperative chest X-ray is unnecessary following the Nuss procedure for pectus excavatum. Interact Cardiovasc Thorac Surg 2013; 16:830-3. [PMID: 23439441 DOI: 10.1093/icvts/ivt052] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Pneumothorax is the most common complication after the Nuss procedure for pectus excavatum. The majority of pneumothoraces are small, and the patients have no symptoms. The aim of this study was to evaluate the necessity for routine chest X-ray immediately after surgery. METHODS Group I consists of 644 patients who were operated on with a Nuss procedure for pectus excavatum between 2001 and 2009 (85% male, median age 16 [range 7-48 years]) at Aarhus University Hospital. The standard procedure included chest X-ray immediately after surgery and before discharge. Group II consists of 294 patients (88% male, median age 16 [range 11-54 years]) who had a Nuss procedure in the period January 2011 to October 2012, where the standard procedure only included chest X-ray before discharge. RESULTS In Group I, pneumothorax was found on the chest X-ray obtained immediately after surgery in 333 (52%) patients. Fifteen (4.5%) were treated with chest-tube drainage. Six of these patients had no symptoms, but a 2- to 3-cm pneumothorax, 2 had progression of the pneumothorax and 7 had respiratory symptoms. The median size of those drained was 3 (range 2-6 cm). At the normal 6-week control, no pneumothorax remained. Group II: Among the 294 patients, 1 (0.3%) had a chest tube. CONCLUSIONS Only patients with respiratory symptoms after the Nuss procedure need a chest X-ray. A routine chest X-ray can be limited to the time of discharge where the position of the bar(s) is also checked.
Collapse
Affiliation(s)
- Mette Reinholdt Knudsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | |
Collapse
|
12
|
de Andrade Filho LO, Kuzniec S, Wolosker N, Yazbek G, Kauffman P, Milanez de Campos JR. Technical difficulties and complications of sympathectomy in the treatment of hyperhidrosis: an analysis of 1731 cases. Ann Vasc Surg 2013; 27:447-53. [PMID: 23406790 DOI: 10.1016/j.avsg.2012.05.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/06/2012] [Accepted: 05/08/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to ascertain the technical difficulties and complications of video-assisted thoracic sympathectomy (VTAS) in the treatment of hyperhidrosis in a large group of patients. METHODS Between October 1995 and February 2008, 1731 patients with palmar, axillary, or craniofacial hyperhidrosis, who were treated using bilateral VTAS, were studied. We assessed the technical difficulties, early and late complications, and the approaches that were used to resolve them. RESULTS Therapeutic success was achieved in 91% of the cases as evidenced by anhidrosis. The most common and severe technical difficulty during the procedure was pleural adhesions in 116 cases (6.7%); azygos lobes were seen in 7 patients (0.4%) and apical blebs in 3 patients (0.2%). The most frequent postoperative immediate complication was postoperative pain in 1685 (97.4%) patients; pneumothorax with chest drainage was seen in 60 cases (3.5%), neurologic disorders involving the upper limbs in 36 cases (2.1%), Horner's syndrome in 11 cases (0.9%), significant bleeding in 8 cases (0.4%), and 1 patient had extensive subcutaneous emphysema. The most frequent late complication was compensatory hyperhidrosis, which occurred in 1531 cases (88.4%). Although 27.2% of the patients reported severe compensatory hyperhidrosis, only 2.5% expressed regret for undergoing surgery. Gustatory sweating occurred in 334 patients (19.3%). No deaths occurred in this series. CONCLUSIONS VTAS is safe and has shown good results. The major complication is compensatory hyperhidrosis and, when severe, the patient may express regret for undergoing surgery. Improvements in instrumentation, adequate training, and careful patient selection may help to reduce the number of drawbacks associated with VTAS.
Collapse
|
13
|
Koskinen LOD, Blomstedt P, Sjöberg RL. Predicting improvement after surgery for palmar hyperhidrosis. Acta Neurol Scand 2012; 126:324-8. [PMID: 22324518 DOI: 10.1111/j.1600-0404.2012.01650.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Endoscopic transthoracic sympathectomy (ETS) is a surgical procedure used to improve Quality of Life (QoL) in patients with treatment resistant palmar hyperhidrosis (PHH). The aim of this study was to test the hypothesis that low preoperative scores on The Everyday Life Questionnaire (EDLQ) would predict QoL improvement after surgery. MATERIALS AND METHODS Pre- and post-operative QoL scores from a series of 30 consecutive patients who underwent ETS at our institution were analyzed. RESULTS Preoperative QoL scores was a significant predictor of post-operative improvement across all dimensions covered by the questionnaire. CONCLUSION Preoperative low QoL can be used as a guide in selecting patients with most improved QoL after ETS.
Collapse
Affiliation(s)
- L.-O. D. Koskinen
- Department of Pharmacology and Clinical Neuroscience; Division of Neurosurgery; Umeå University; Umeå; Sweden
| | - P. Blomstedt
- Department of Pharmacology and Clinical Neuroscience; Division of Neurosurgery; Umeå University; Umeå; Sweden
| | - R. L. Sjöberg
- Department of Pharmacology and Clinical Neuroscience; Division of Neurosurgery; Umeå University; Umeå; Sweden
| |
Collapse
|
14
|
Martinez-Barenys C, Pérez J, López De Castro P, Melero A, Mesa M, García S, Fernández E, Astudillo J. [Initial experience of a program of clipping the sympathetic nervous system for the treatment of hyperhidrosis and facial flush]. Cir Esp 2012; 91:115-20. [PMID: 22520560 DOI: 10.1016/j.ciresp.2012.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Accepted: 02/15/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVE To evaluate the results of our program of clipping the thoracic sympathetic nervous system (TSNS) for the treatment of facial flush and/or hyperhidrosis (HH), and to compare the methodology-results of the program development phase (A: January 2007-April 2009) and its consolidation phase (B: May 2009-March 2010). MATERIAL AND METHODS The program included a total of 44 patients (88 procedures) subjected to videothoracoscopy and clipping of the TSNS in a one day surgery unit. Data were collected and analysed retrospectively, and a descriptive and comparative statistical analysis was performed between the two periods (A and B). RESULTS The overall morbidity was 5 cases (11.3%). The post-surgical occurrence rate of HH was 4.54% (2 cases), and the incidence of compensatory sweating was 65.9% (minimal in 26 of the 29 cases). On comparing period B with period A, there was a significant decrease in surgical time, disappearance of recurrence of HH, a decrease of 30% in morbidity, reduction by half in the incidence of moderate to severe compensatory sweating, and an increase in the level of satisfaction. The clamps were removed in one of the poorly tolerated compensatory sweating cases, resulting in its disappearance. CONCLUSIONS Clipping the TSNS is a safe technique in the one day surgery unit, with a short learning curve (20 cases) after which comparable, or even better, results are obtained than those of sympatholysis. These results, together with their potential reversibility, makes it, in our opinion, the technique of choice in the surgery of the TSNS.
Collapse
Affiliation(s)
- Carlos Martinez-Barenys
- Servicio de Cirugía Torácica, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Sympathetic chain clipping for hyperhidrosis is not a reversible procedure. Surg Endosc 2011; 26:1258-63. [DOI: 10.1007/s00464-011-2023-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 10/17/2011] [Indexed: 11/26/2022]
|
16
|
Hoorens I, Ongenae K. Primary focal hyperhidrosis: current treatment options and a step-by-step approach. J Eur Acad Dermatol Venereol 2011; 26:1-8. [PMID: 21749468 DOI: 10.1111/j.1468-3083.2011.04173.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Primary focal hyperhidrosis is a common disorder for which treatment is often a therapeutic challenge. A systematic review of current literature on the various treatment modalities for primary focal hyperhidrosis was performed and a step-by-step approach for the different types of primary focal hyperhidrosis (axillary, palmar, plantar and craniofacial) was established. Non-surgical treatments (aluminium salts, local and systemic anticholinergics, botulinum toxin A (BTX-A) injections and iontophoresis) are adequately supported by the current literature. More invasive surgical procedures (suction curettage and sympathetic denervation) have also been extensively investigated, and can offer a more definitive solution for cases of hyperhidrosis that are unresponsive to non-surgical treatments. There is no consensus on specific techniques for sympathetic denervation, and this issue should be further examined by meta-analysis. There are numerous treatment options available to improve the quality of life (QOL) of the hyperhidrosis patient. In practice, however, the challenge for the dermatologist remains to evaluate the severity of hyperhidrosis to achieve the best therapeutic outcome, this can be done most effectively using the Hyperhidrosis Disease Severity Scale (HDSS).
Collapse
Affiliation(s)
- I Hoorens
- Department of Dermatology, University Hospital, Ghent, Belgium.
| | | |
Collapse
|
17
|
Guidelines on surgery of the thoracic sympathetic nervous system. Arch Bronconeumol 2011; 47:94-102. [PMID: 21342743 DOI: 10.1016/j.arbres.2010.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 05/29/2010] [Indexed: 11/23/2022]
Abstract
Thoracic sympathetic nervous system (TSNS) surgery has increased in importance in the last few years, generating great expectations among the general population and the scientific community. This has been due to the excellent results obtained by videothoracoscopy-assisted thoracic sympathectomy in the treatment of essential hyperhidrosis and other TSNS disorders. This minimally invasive surgical technique has been shown to be effective, and with a low morbidity it is accepted as one of the best therapeutic options for the treatment of palmar and bilateral axillary hyperhidrosis and the number of patients consulting with the intention of having the operation has increased considerably. Although compensatory sweating, which is occasionally intense, often occurs after the surgery, this and other secondary effects of the technique are well tolerated by patients. The current evidence on TSNS and the treatment of essential hyperhidrosis is based on observational studies, making it difficult to compare series and draw conclusions. There has been much discussion on standardising the technique, defining the most favourable levels for clipping, and choosing the type of denervation with least secondary effects. This has led to the need to draw up these guidelines which should clarify and standardise the criteria for managing patients with disorders of TSNS.
Collapse
|
18
|
Wait SD, Killory BD, Lekovic GP, Ponce FA, Kenny KJ, Dickman CA. Thoracoscopic Sympathectomy for Hyperhidrosis. Neurosurgery 2010; 67:652-6; discussion 656-7. [DOI: 10.1227/01.neu.0000374719.32137.bb] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND
Hyperhidrosis (HH) profoundly affects a patient's well-being.
OBJECTIVE
We report indications and outcomes of 322 patients treated for HH via thoracoscopic sympathectomy or sympathotomy at the Barrow Neurological Institute.
METHODS
A prospectively maintained database of all patients who underwent sympathectomy or sympathotomy between 1996 and 2008 was examined. Additional follow-up was obtained in clinic, by phone, or by written questionnaire.
RESULTS
A total of 322 patients (218 female patients) had thoracoscopic treatment (mean age 27.6 years; range, 10–60 years). Mean follow-up was 8 months. Presentations included HH of the palms (43 patients, 13.4%), axillae (13 patients, 4.0%), craniofacial region (4 patients, 1.2%), or some combination (262 patients, 81.4%). Sympathectomy and sympathotomy were equally effective in relieving HH. Palmar HH resolved in 99.7% of patients. Axillary or craniofacial HH resolved or improved in 89.1% and 100% of cases, respectively. Hospital stay averaged 0.5 days. Ablating the sympathetic chain at T5 increased the incidence of severe compensatory sweating (P = .0078). Sympathectomy was associated with a significantly higher incidence of Horner's syndrome compared with sympathotomy (5% vs 0.9%, P = .0319). Patients reported satisfaction and willingness to undergo the procedure again in 98.1% of cases.
CONCLUSION
Thoracoscopic sympathectomy is effective and safe treatment for severe palmar, axillary, and craniofacial HH. Ablating the T5 ganglion tends to increase the severity of compensatory sweating. Sympathectomy led to a higher incidence of ipsilateral Horner's syndrome compared with sympathotomy.
Collapse
Affiliation(s)
- Scott D. Wait
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Brendan D. Killory
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | - Francisco A. Ponce
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kathy J. Kenny
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Curtis A. Dickman
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| |
Collapse
|
19
|
Congregado M. Impacto de la simpatectomía dorsal videotoracoscópica en la cirugía torácica. Implicaciones futuras. Arch Bronconeumol 2010; 46:1-2. [PMID: 20004506 DOI: 10.1016/j.arbres.2009.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Revised: 10/22/2009] [Accepted: 10/29/2009] [Indexed: 10/20/2022]
|
20
|
Freeman RK, Van Woerkom JM, Vyverberg A, Ascioti AJ. Reoperative endoscopic sympathectomy for persistent or recurrent palmar hyperhidrosis. Ann Thorac Surg 2009; 88:412-6; discussion 416-7. [PMID: 19632385 DOI: 10.1016/j.athoracsur.2009.03.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Revised: 03/24/2009] [Accepted: 03/25/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Sympathectomy for severe palmar hyperhidrosis occasionally fails. This investigation reviews our experience with reoperative thoracoscopic sympathectomy (RS) for patients with persistent or recurrent palmar hyperhidrosis after sympathectomy. METHODS A retrospective analysis of patients undergoing RS for palmar hyperhidrosis was conducted. Comparison was made with all patients undergoing an initial thoracoscopic sympathectomy (TS) for palmar hyperhidrosis at our institution during the same period. RESULTS Over 6 years, 40 patients underwent bilateral (32) or unilateral (8) RS for refractory (35) or recurrent (5) palmar hyperhidrosis. During the same period, 321 patients underwent bilateral TS for palmar hyperhidrosis. Previous methods of sympathectomy included percutaneous ablation (25), TS (10), axillary thoracotomy (3), and a posterior transthoracic approach (2). Twenty-two RS patients and 11 TS patients required a third port to complete the procedure because of pleural adhesions (p = 0.0001). Twenty-three RS and 11 TS patients required postoperative pleural drainage (p = 0.0004). Mean length of stay was1.6 for the RS group and less than 1 day for the TS group (p = 0.0001). Alleviation of palmar hyperhidrosis occurred in 38 RS patients and 316 TS patients (p = 0.18). Compensatory sweating was identified in 21 RS patients and 101 TS patients (p = 0.01). CONCLUSIONS Reoperative thoracoscopic sympathectomy produced a rate of improvement comparable to that of TS. However, RS was associated with an increased need for postoperative pleural drainage, longer hospital stay, a more difficult operative procedure, and a higher rate of compensatory sweating than TS was. Reoperative sympathectomy should be considered a safe and effective option for patients with palmar hyperhidrosis who remain severely symptomatic after a sympathectomy.
Collapse
Affiliation(s)
- Richard K Freeman
- Department of Thoracic and Cardiovascular Surgery, St Vincent Hospital, Indianapolis, Indiana, USA.
| | | | | | | |
Collapse
|