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Sang HW, Li GL, Xiong P, Zhu MC, Zhu M. Optimal targeting of sympathetic chain levels for treatment of palmar hyperhidrosis: an updated systematic review. Surg Endosc 2017; 31:4357-4369. [PMID: 28389800 DOI: 10.1007/s00464-017-5508-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/08/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Palmar hyperhidrosis involves excessive sweating of the palms, with no known etiology. Endoscopic thoracic sympathectomy (ETS) is a safe and effective treatment for palmar hyperhidrosis, but compensatory hyperhidrosis is a common complication after ETS, leading to reduced patient satisfaction and postoperative quality of life. However, the appropriate level of the sympathetic chain to target with ETS to achieve maximum efficacy and reduce the risk of compensatory hyperhidrosis (CH) is controversial. In this systemic review, we investigated the appropriate level of sympathectomy for palmar hyperhidrosis. METHODS PRISMA guidelines were implemented to complete a systematic review. We performed a computerized systematic literature search using PubMed and EMBASE from January 1990 to July 2016. We chose the Cochrane Collaboration's tool and the methodological index for non-randomized studies tool for examining study bias. RESULTS A total of 4075 citations were identified, of which 91 were eligible for inclusion, including 68 observational studies and 23 comparative trials. In observational studies, sympathectomies showed similar efficacies for curing PH at different levels. However, T2-free groups (i.e., at levels T3, T4, or T3-T4 combined) could render a lower risk of Horner's syndrome (0 vs. 1.21 ± 0.49%, p = 0.036) and CH (28.75 ± 7.25 vs. 57.46 ± 3.86, p = 0.002) compared with T2 involved. In comparative trials, there were 12 studies describing the comparison between T2-free ETS and T2 involved, and 9 of 12 (75%) showed T2-free ETS could reduce the incidence of CH. Overall, lowering the level and limiting the extent of sympathectomy could reduce the incidence of complications. CONCLUSIONS Cumulative data from more than 13,000 patients suggest that ETS is a safe, effective, and reproducible procedure with a high degree of patient satisfaction. Currently available evidence suggests that T2-free ETS may reduce the incidence of compensatory hyperhidrosis without compromising success rates and safety.
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Affiliation(s)
- Hai-Wei Sang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, Hubei, China.,Department of Thoracic Surgery, First Affiliated Hospital of Bengbu Medical College, 287 Chang Huai Road, Bengbu, 233004, Anhui, China
| | - Guo-Liang Li
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, Hubei, China
| | - Peng Xiong
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, Hubei, China
| | - Ming-Chuang Zhu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, Hubei, China
| | - Min Zhu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, Hubei, China.
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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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Hashmonai M, Assalia A, Kopelman D. Thoracoscopic sympathectomy for palmar hyperhidrosis. Surg Endosc 2014; 15:435-41. [PMID: 11353955 DOI: 10.1007/s004640080042] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2000] [Accepted: 11/21/2000] [Indexed: 10/28/2022]
Abstract
BACKGROUND Upper thoracoscopic sympathectomy, obtained either by ablation or resection of the appropriate ganglia, is now the preferred treatment for primary palmar hyperhidrosis. Therefore, we undertook a review to compare the relative efficacy of these two techniques. METHODS A Medline search was performed for the years 1974-99 to identify all published studies of thoracoscopic sympathectomy for hyperhidrosis. RESULTS In all, 33 studies were identified and divided into two groups-ablation and resection. When the resection method was used, the immediate success rate was 99.76%, whereas the ablation method achieved dry hands in 95.2% of cases (p = 0.00001). Palmar sweating recurred in 0% of patients treated via resection and -4.4% treated with ablation. Ptosis was noted in 0.92% of cases after ablation and in 1.72% after resection (p = 0.017). CONCLUSIONS Resection yields superior results, yet the majority of surgeons ablate, probably because it is easier, requires a shorter operating time, leads to fewer cases of Horner's syndrome, and because resympathectomy eventually overcomes initial failure.
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Affiliation(s)
- M Hashmonai
- Department of Surgery B, The Rambam Medical Center and the Faculty of Medicine, Technion Israel Institute of Technology, P.O. Box 9621, Haifa 31096, Israel.
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Vanderhelst E, De Keukeleire T, Verbanck S, Vincken W, Noppen M. Quality of Life and Patient Satisfaction After Video-Assisted Thoracic Sympathicolysis for Essential Hyperhidrosis: A Follow-Up of 138 Patients. J Laparoendosc Adv Surg Tech A 2011; 21:905-9. [DOI: 10.1089/lap.2011.0258] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eef Vanderhelst
- Respiratory Division, University Hospital Brussels UZB, Brussels, Belgium
| | - Tom De Keukeleire
- Respiratory Division, University Hospital Brussels UZB, Brussels, Belgium
| | - Sylvia Verbanck
- Respiratory Division, University Hospital Brussels UZB, Brussels, Belgium
| | - Walter Vincken
- Respiratory Division, University Hospital Brussels UZB, Brussels, Belgium
| | - Marc Noppen
- Respiratory Division, University Hospital Brussels UZB, Brussels, Belgium
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Vorkamp T, Foo FJ, Khan S, Schmitto JD, Wilson P. Hyperhidrosis: Evolving concepts and a comprehensive review. Surgeon 2010; 8:287-92. [PMID: 20709287 DOI: 10.1016/j.surge.2010.06.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 05/28/2010] [Accepted: 06/01/2010] [Indexed: 11/20/2022]
Affiliation(s)
- Tobias Vorkamp
- Department of Thoracic, Cardiac and Vascular Surgery, University of Goettingen, Germany
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Kopelman D, Hashmonai M. The correlation between the method of sympathetic ablation for palmar hyperhidrosis and the occurrence of compensatory hyperhidrosis: a review. World J Surg 2009; 32:2343-56. [PMID: 18797962 DOI: 10.1007/s00268-008-9716-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Upper dorsal sympathectomy achieves excellent long-term results in the treatment of primary palmar hyperhidrosis. Compensatory hyperhidrosis (CHH) remains an unexplained sequel of this treatment, attaining in a small percentage of cases disastrous proportions. It has been claimed that lowering the level of sympathectomy (from T2 to T3 and even T4), substituting resection by other means of ablation, and limiting its extend reduce the occurrence of this sequel. This review was designed to evaluate the validity of these claims. METHODS A MEDLINE search was performed for the years 1990--2006 and all publications about thoracoscopic upper dorsal sympathectomy for hyperhidrosis were retrieved. RESULTS The search identified 42 techniques of sympathetic ablation. However, pertinent data for the present study were reported for only 23 techniques with multiple publications found only for 10. The only statistically valid results from this review point that T2 resection and R2 transection of the chain (over the second rib) ensue in less CHH than does electrocoagulation of T2. Further comparisons were probably prevented due to the enormous disparity in the reported results, indicating lack of standardization in definitions. CONCLUSIONS The compiled results published so far in the literature do not support the claims that lowering the level of sympathetic ablation, using a method of ablation other than resection, or restricting the extend of sympathetic ablation for primary palmar hyperhidrosis result in less CHH. In the future, standardization of the methods of retrieving and reporting data are necessary to allow such a comparison of data.
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Affiliation(s)
- Doron Kopelman
- Department of Surgery B, Ha'emek Hospital, Afula, Israel
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Dexter F, Dexter EU, Masursky D, Nussmeier NA. Systematic review of general thoracic surgery articles to identify predictors of operating room case durations. Anesth Analg 2008; 106:1232-41, table of contents. [PMID: 18349199 DOI: 10.1213/ane.0b013e318164f0d5] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Previous studies of operating room (OR) information systems data over the past two decades have shown how to predict case durations using the combination of scheduled procedure(s), individual surgeon and assistant(s), and type of anesthetic(s). We hypothesized that the accuracy of case duration prediction could be improved by the use of other electronic medical record data (e.g., patient weight or surgeon notes using standardized vocabularies). METHODS General thoracic surgery was used as a model specialty because much of its workload is elective (scheduled) and many of its cases are long. PubMed was searched for thoracic surgery papers reporting operative time, surgical time, etc. The systematic literature review identified 48 papers reporting statistically significant differences in perioperative times. RESULTS There were multiple reports of differences in OR times based on the procedure(s), perioperative team including primary surgeon, and type of anesthetic, in that sequence of importance. All such detail may not be known when the case is originally scheduled and thus may require an updated duration the day before surgery. Although the use of these categorical data from OR systems can result in few historical data for estimating each case's duration, bias and imprecision of case duration estimates are unlikely to be affected. There was a report of a difference in case duration based on additional information. However, the incidence of the procedure for the diagnosis was so uncommon as to be unlikely to affect OR management. CONCLUSIONS Matching findings of prior studies using OR information system data, multiple case series show that it is important to rely on the precise procedure(s), surgical team, and type of anesthetic when estimating case durations. OR information systems need to incorporate the statistical methods designed for small numbers of prior surgical cases. Future research should focus on the most effective methods to update the prediction of each case's duration as these data become available. The case series did not reveal additional data which could be cost-effectively integrated with OR information systems data to improve the accuracy of predicted durations for general thoracic surgery cases.
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Affiliation(s)
- Franklin Dexter
- Department of Anesthesia, University of Iowa, Iowa City, IA 52242, USA.
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Solish N, Bertucci V, Dansereau A, Hong HCH, Lynde C, Lupin M, Smith KC, Storwick G. A comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: recommendations of the Canadian Hyperhidrosis Advisory Committee. Dermatol Surg 2007; 33:908-23. [PMID: 17661933 DOI: 10.1111/j.1524-4725.2007.33192.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hyperhidrosis can have profound effects on a patient's quality of life. Current treatment guidelines ignore disease severity. OBJECTIVE The objective was to establish clinical guidelines for the recognition, diagnosis, and treatment of primary focal hyperhidrosis. METHODS AND MATERIALS A working group of eight nationally recognized experts was convened to develop the consensus statement using an evidence-based approach. RECOMMENDATIONS An algorithm was designed to consider both disease severity and location. The Hyperhidrosis Disease Severity Scale (HDSS) provides a qualitative measure that allows tailoring of treatment. Mild axillary, palmar, and plantar hyperhidrosis (HDSS score of 2) should initially be treated with topical aluminum chloride (AC). If the patient fails to respond to AC therapy, botulinum toxin A (BTX-A; axillae, palms, soles) and iontophoresis (palms, soles) should be the second-line therapy. In severe cases of axillary, palmar, and plantar hyperhidrosis (HDSS score of 3 or 4), both BTX-A and topical AC are first-line therapy. Iontophoresis is also first-line therapy for palmar and plantar hyperhidrosis. Craniofacial hyperhidrosis should be treated with oral medications, BTX-A, or topical AC as first-line therapy. Local surgery (axillary) and endoscopic thoracic sympathectomy (palms and soles) should only be considered after failure of all other treatment options. CONCLUSIONS These guidelines offer a rapid method to assess disease severity and to treat primary focal hyperhidrosis according to severity.
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Affiliation(s)
- Nowell Solish
- Division of Dermatology, New Women's College Hospital, Toronto, Ontario, Canada.
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A Comprehensive Approach to the Recognition, Diagnosis, and Severity-Based Treatment of Focal Hyperhidrosis. Dermatol Surg 2007. [DOI: 10.1097/00042728-200708000-00003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Singh B, Moodley J, Allopi L, Cassimjee HM. Horner syndrome after sympathectomy in the thoracoscopic era. Surg Laparosc Endosc Percutan Tech 2007; 16:222-5. [PMID: 16921300 DOI: 10.1097/00129689-200608000-00005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Horner syndrome after sympathectomy has significantly decreased in current surgical practice. This is predominantly due to refinements in operative techniques, and an improved understanding of the patterns of sympathetic outflow pathways. We present a review of our experience with this disconcerting complication of sympathectomy when undertaken for palmar hyperhidrosis. METHODS AND TECHNIQUE Over a 12-year period (1992 to 2004), patients undergoing sympathectomy for palmar hyperhidrosis were prospectively evaluated. In all patients the thoracoscopic approach was attempted bilaterally. The technique entailed the accurate identification of the second thoracic ganglion, followed by its dissection and resection. Excessive manipulation and cautery on the sympathetic chain was avoided. RESULTS A total of 1137 procedures were undertaken in 567 patients. In 1 patient (during the early part of the technical experience) a unilateral Horner syndrome was noted on the first postoperative day; this effect was noted to have resolved spontaneously within 6 months. Review at 3 months was possible in 382 patients, either directly or telephonically. In these patients no further case of Horner syndrome was documented. CONCLUSIONS The key to avoiding the development of a Horner syndrome after sympathectomy entails a thorough appreciation of the appropriate surgical anatomy, avoidance of violent manipulation and traction of the sympathetic chain, and the avoidance of diathermy on the sympathetic chain. The adherence to these principles has consigned Horner syndrome after sympathectomy as an entity of historical interest.
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Affiliation(s)
- Bhugwan Singh
- Department of Surgery, Nelson R Mandela School of Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Private Bag 7, Congella 4013, South Africa.
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Malmivaara A, Kuukasjärvi P, Autti-Ramo I, Kovanen N, Mäkelä M. Effectiveness and safety of endoscopic thoracic sympathectomy for excessive sweating and facial blushing: A systematic review. Int J Technol Assess Health Care 2007; 23:54-62. [PMID: 17234017 DOI: 10.1017/s0266462307051574] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives:Despite controversies, endoscopic thoracic sympathectomy (ETS) has been used as a treatment for excessive sweating of hands and face and for facial blushing. This study aims to evaluate the effectiveness of ETS for the current indications in a systematic review.Methods:Controlled clinical trials and cohort studies with more than 100 patients were included. Abstracts were searched from MEDLINE and CCTR from 1966 to June 2004. Two reviewers extracted the data and assessed study quality. Data on effectiveness and safety were synthesized qualitatively.Results:We did not find any controlled clinical trials. Fifteen prospective studies were included. The internal and external quality of these studies were poor overall. Follow-up was commonly less than 2 years, during which time excessive sweating and facial blushing seemed to decrease among most patients. Immediate complications related to thoracoscopy occurred in up to 10 percent of patients. Compensatory sweating below breast level was reported in up to 90 percent of the patients. Other common side effects included dryness of face and hands, gustatory sweating, and neuralgic pain. Several other less common side effects were reported.Conclusions:The evidence of the effectiveness of ETS is weak due to a lack of randomized trials. The intervention leads to severe immediate complications in some of the patients, and to persistent side-effects for many of the patients.
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Affiliation(s)
- Antti Malmivaara
- Finnish Office for Health Technology Assessment, and Department of Physiatrics, University of Oulu, Box 8000, 90014 University of Oulu, Finland.
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Licht PB, Pilegaard HK. Gustatory Side Effects After Thoracoscopic Sympathectomy. Ann Thorac Surg 2006; 81:1043-7. [PMID: 16488719 DOI: 10.1016/j.athoracsur.2005.09.044] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Revised: 09/14/2005] [Accepted: 09/21/2005] [Indexed: 11/24/2022]
Abstract
BACKGROUND Compensatory sweating is a frequent side effect after thoracoscopic sympathectomy for primary hyperhidrosis. Gustatory sweating is less commonly reported. It is defined as facial sweating when eating certain foods (particularly spicy food or acidic fruits) and has no generally accepted pathophysiologic explanation. We decided to investigate this phenomenon in patients who underwent thoracoscopic sympathectomy for primary hyperhidrosis and analyze whether the occurrence was influenced by the extent of sympathectomy. METHODS During an 8-year period (1997 to 2005) a total of 238 patients were treated by thoracoscopic sympathectomy for primary hyperhidrosis or blushing. Sympathectomy was performed bilaterally at T2 for facial hyperhidrosis or blushing (n = 97), T2-T3 for palmar hyperhidrosis (n = 76), and T2-T4 for axillary hyperhidrosis (n = 65). All patients received the same questionnaire at follow-up. RESULTS The questionnaire was returned by 96% of patients after a median of 17 months. Overall, gustatory sweating occurred in 32% of patients, and the incidence was significantly associated with extent of sympathectomy (p = 0.04). However, because the extent of sympathectomy was always decided by the location of primary hyperhidrosis, the latter may also explain the risk of gustatory sweating. CONCLUSIONS Gustatory sweating is a frequent side effect after thoracoscopic sympathectomy. This is the first study to report that its incidence is significantly related to the extent of sympathectomy or the location of primary hyperhidrosis. Although there is no pathophysiologic explanation of gustatory sweating, these findings should be considered before planning thoracoscopic sympathectomy and patients should be thoroughly informed.
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Affiliation(s)
- Peter B Licht
- Department of Cardiothoracic Surgery, Skejby Sygehus, Aarhus University Hospital, Aarhus, Denmark.
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Moya J, Ramos R, Morera R, Villalonga R, Perna V, Macia I, Ferrer G. Thoracic sympathicolysis for primary hyperhidrosis: a review of 918 procedures. Surg Endosc 2006; 20:598-602. [PMID: 16437263 DOI: 10.1007/s00464-005-0557-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Accepted: 11/21/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Bilateral upper thoracic sympathectomy or sympathicolysis, currently the standard treatment for palmar or axillary hyperhidrosis, is regarded as a safe procedure. This study evaluates the quantitative and qualitative incidence of intraoperative and postoperative complications resulting from bilateral thoracic sympathicolysis. METHODS From 1996 to 2004, 458 consecutive patients with primary hyperhidrosis underwent surgery. These patients comprised 143 men (31.2%) and 315 women (68.7%) with a mean age of 26 years (range, 14-52 years). In all but seven cases, the procedure was bilaterally synchronous. RESULTS No mortality was recorded. The anhydrosis rate was 97.4%, with a hypohidrosis rate of 2.4% and a failure rate of 0.2%. The latter was resolved with reintervention. The mean hospital stay was 17 h. The rate of major perioperative complications with conversion to thoracotomy was 0.4%. The overall rate of postoperative complications was 3.6%. The complications and rates observed were as follows: pneumothorax (2.06%), subcutaneous emphysema (1.08%), pleural bleeding (0.2%), hemothorax (0.1%), and atelectasis (0.1%). Compensatory hyperhidrosis was observed in 48.4% of the patients, but the sensation of compensatory hyperhidrosis was reported in 85.6% of the cases. Excessive dryness of the hands was reported in 0.38%, Horner's syndrome in 0.32%, and gustatory hyperhidrosis in 1.1% of the cases. The overall satisfaction rate was 88.5%. CONCLUSIONS The results suggest that endoscopic bilateral thoracic sympathicolysis is an effective method for managing primary hyperhidrosis, especially severe palmar hyperhidrosis, but it is necessary to inform patients fully concerning the undesirable effects.
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Affiliation(s)
- J Moya
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907, Barcelona, Spain.
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Rizzo M, Balderson SS, Harpole DH, Levin LS. Thoracoscopic sympathectomy in the management of vasomotor disturbances and complex regional pain syndrome of the hand. Orthopedics 2004; 27:49-52. [PMID: 14763530 DOI: 10.3928/0147-7447-20040101-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Complex regional pain syndrome, vasospastic disorders, and hyperhidrosis are chronic and debilitating upper extremity problems. Twenty-nine consecutive patients treated with thoracoscopic sympathectomy are presented. Diagnoses included complex regional pain syndrome, hyperhidrosis, Buerger's disease, Raynaud's disease, and peripheral vascular disease. All patients with hyperhidrosis had complete symptom resolution. Patients with Buerger's and Raynaud's disease had excellent/good results. Six patients with complex regional pain syndrome had excellent or good relief; the remaining six patients had varying degrees of recurrence. A statistically significant association was noted between duration of complex regional pain syndrome prior to sympathectomy and outcome. Thoracoscopic sympathectomy is an effective treatment for hyperhidrosis and vasospastic disorders. Although the results for complex regional pain syndrome are not uniformly excellent, this technique offers promise in the treatment of this difficult problem.
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Affiliation(s)
- Marco Rizzo
- Division of Orthopedic, Duke University Medical Center, Box 3945, Durham, NC 27710, USA
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Gossot D, Galetta D, Pascal A, Debrosse D, Caliandro R, Girard P, Stern JB, Grunenwald D. Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis. Ann Thorac Surg 2003; 75:1075-9. [PMID: 12683540 DOI: 10.1016/s0003-4975(02)04657-x] [Citation(s) in RCA: 156] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Immediate results of endoscopic thoracic sympathectomy (ETS) for hyperhidrosis are good. Adverse effects are well known but are supposed to decrease with time. We report the long-term results of ETS with regard to efficacy, side effects and patient satisfaction. METHODS From 1993 to 1998, 382 patients suffering from hyperhidrosis of the upper limbs were operated on by means of bilateral ETS. One hundred twenty-five could be reached. There were 91 females and 34 males with a mean age of 28 years. The mean follow-up was 3.8 years (range: 24 to 84 months). Patients answered a detailed questionnaire from an independent observer addressing the following issues: stability of the initial result, outcome of side effects, degree of satisfaction. RESULTS The global recurrence rate was 8.8%: 6.6% for palmar hyperhidrosis and 65% for axillary hyperhidrosis. Compensatory sweating was observed in 86.4% of the patients. It was considered as minor by 61% of them, as embarrassing by 31.5%, and as disabling by 7.5%. Other reported side effects were: Horner's syndrome in 3 patients (2.4%), healing in 2 of them; chronic rhinitis in 3 (2.4%); gustatory sweating in 9 (7.2%); and hand dryness in 42%. Sixty-five percent of the patients were fully satisfied, 28.7% were globally satisfied, and 6.3% regretted the operation. Ninety-two percent of the patients claimed they would ask for the operation if it were to be redone. CONCLUSIONS This study confirms that results of ETS are good and stable for palmar hyperhidrosis but deteriorate for axillary hyperhidrosis. Compensatory sweating does not improve with time and is the main cause of dissatisfaction. Recommendations drawn from these results are the following: (1) patients suffering from isolated axillary hyperhidrosis should rather be treated by local therapy; (2) patients should be better informed of adverse effects.
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Affiliation(s)
- Dominique Gossot
- Thoracic Department, Institut Mutualiste Montsouris, Paris, France.
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Gossot D, Kabiri H, Caliandro R, Debrosse D, Girard P, Grunenwald D. Early complications of thoracic endoscopic sympathectomy: a prospective study of 940 procedures. Ann Thorac Surg 2001; 71:1116-9. [PMID: 11308146 DOI: 10.1016/s0003-4975(01)02422-5] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Thoracic endoscopic sympathectomy (TES) has become the surgical technique of choice for treating intractable palmar hyperhidrosis and is usually considered as a simple and safe procedure. To evaluate the complication rate of TES, we conducted a prospective study of peri- and postoperative complications. METHODS From 1995 to 1999, 467 consecutive patients were operated on for upper limb hyperhidrosis. There were 164 men and 303 women, ranging in age from 15 to 59 years (mean 31 years). In all but 5 cases, the procedure was bilateral. Eleven patients underwent a reoperation for failure; thus the total number of sympathectomies was 940. The procedure was performed in two stages in 182 patients and in one stage in 267 patients. All patients were seen 1 month after the operation. RESULTS There was no mortality. The mean postoperative hospital stay was 2.3 days in the group of patients who were operated on in two stages and 1.1 day in patients who were operated on in one stage. There were three major complications: one tear of the right subclavian artery and two chylothoraces. There were 25 cases (5.3%) of bleeding (300 to 600 mL) during dissection of the sympathetic trunk due to injury to an intercostal vein; in all cases it was controlled thoracoscopically. There were 12 pneumothoraces (1.3%) after removal of chest tubes. All of these were unilateral. Four required chest drainage for a period of less than 24 hours. One patient had a mild pleural effusion. Four patients had a unilateral partial Horner Syndrome (0.4%) that disappeared within 3 months in 2 patients. The other 2 patients were lost to follow-up. One patient complained of rhinitis. CONCLUSIONS Although morbidity was low, significant complications of TES occurred. Patients should be clearly warned that TES is not as minor a procedure as usually asserted. Complications as well as adverse effects should be considered when discussing this surgical indication.
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Affiliation(s)
- D Gossot
- Thoracic Department, Institut Mutualiste Montsouris, Paris, France.
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