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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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Felisberto G, Maria Cataneo AJ, Cristina Cataneo D. Thoracic sympathectomy for the treatment of primary axillary hyperhidrosis: systematic review and proportional meta-analysis. Ann Med 2021; 53:1216-1226. [PMID: 34282698 PMCID: PMC8293952 DOI: 10.1080/07853890.2021.1953126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 07/02/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Primary hyperhidrosis is a disorder that involves excessive sweat production, which has a negative impact on the quality of life. OBJECTIVE To evaluate the effectiveness and safety of video-assisted thoracoscopic sympathectomy (VATS) for treating primary axillary hyperhidrosis (PAH) and determine which level of ganglion resection offers the best outcome. METHOD This was a systematic review and proportional meta-analysis of observational studies. The result was evaluated for satisfaction, control of symptoms, compensatory sweating and complications. A subgroup analysis was performed to compare the sympathetic trunk resection at high and low levels. RESULTS Thirteen studies were selected with a total of 1463 patients. The satisfaction rate was 92% (95% CI = 88-95%, I2=47.5%), the symptom control rate was 96% (95% CI = 93-99%, I2=48.2%), and the presence of compensatory sweating could not be assessed because of high heterogeneity among studies. The complications were rare. CONCLUSION This review demonstrated that thoracic sympathectomy by VATS is a viable and safe option for the treatment of PAH. There was no difference between high and lower levels of resection. However, the estimation of the effect is quite uncertain because the quality of evidence was extremely low.Key messagePure axillary hyperhidrosis has great potential to compromise quality of life.Surgery should be indicated only when clinical treatment fails.Thoracic sympathectomy by video-assisted thoracoscopy is a viable and safe option for the treatment of primary axillary hyperhidrosis.
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Affiliation(s)
- Gilmar Felisberto
- Department of Surgery, Post-Graduation Program in Surgery and Translational Medicine, Botucatu School of Medicine, São Paulo State University, UNESP, São Paulo, Brazil
| | - Antônio José Maria Cataneo
- Department of Surgery, Division of Thoracic Surgery, Botucatu School of Medicine, São Paulo State University, UNESP, São Paulo, Brazil
| | - Daniele Cristina Cataneo
- Department of Surgery, Division of Thoracic Surgery, Botucatu School of Medicine, São Paulo State University, UNESP, São Paulo, Brazil
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Mohammad Khalil A, Makram Botros J, Boules ML, Salama AK, Gaber Ragab S. Safety of Radiofrequency Ablation of Thoracic T2 and T3 Sympathectomy in Palmar Hyperhidrosis: A Case Report. Anesth Pain Med 2021; 11:e114827. [PMID: 34540640 PMCID: PMC8438739 DOI: 10.5812/aapm.114827] [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: 04/13/2021] [Revised: 05/16/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Hyperhidrosis is the maladjustment of excess sweating in specific parts of the body. Radiofrequency (RF) therapy has been successfully used to treat hyperhidrosis with a success rate of 85% - 95% in patients refractory to sympathectomy. The main hypothesis was the association between reduced palmar hyperhidrosis and radiofrequency RF therapy. The RF therapy is a less invasive technique, including the utilization of electromagnetic energy that is deposited near the nerve tissue. The mechanism of action of continuous RF could be explained by the destruction of afferent nerve fibers on their way from a nociceptive focus to the central nervous system. Pulsed RF was invented to explore this possibility, with the sole purpose of finding a less destructive and equally effective technique for the application of RF to afferent pathways. Herein, we further evaluated whether the procedure was safe without any complications in routine follow-up in palmar hyperhidrosis. Case Presentation Herein, we report the case of a male patient with an age of 22 years undergoing thermal RF sympathectomy therapy of thoracic T2 and T3 sympathetic ganglia for the palmar hyperhidrosis of his right hand observed for 3 months. The patient developed a contraction of the flexor involving the small muscles of the right hand with severe pain and congestion 17 days after the procedure without any other complications. The contraction was relieved by a sonar-guided median nerve block at the wrist with two injections of 2 mL lidocaine 2% and 2 mL dexamethasone. Conclusions This study has been the first clinical case report complicated by the development of a contraction of the flexor muscles of the right hand with severe pain and congestion. The spasm was gradually relieved by sonar-guided median nerve injection at the level of the wrist and intended to assess the role of RF ablation with a success rate of 85% - 95% in palmar hyperhidrosis.
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Affiliation(s)
- Atef Mohammad Khalil
- Fayoum University Hospital, Fayoum, Egypt
- Corresponding Author: Fayoum University Hospital, Fayoum, Egypt.
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Toolabi K, Parsaei R, Farid R, Zamanian A. Endoscopic thoracic sympathotomy for primary hyperhidrosis: predictors of outcome over a 10-year period. Surg Endosc 2021; 36:3585-3591. [PMID: 34426874 DOI: 10.1007/s00464-021-08684-8] [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: 10/09/2020] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Endoscopic thoracic sympathectomy/sympathotomy is gold standard of treatment for primary hyperhidrosis. Compensatory hyperhidrosis following surgery and partial response to surgery in some patients can significantly affect surgery outcome and patient satisfaction. In this study we investigated predictors of success rate, side effects, and satisfaction of our patients following ETS over a 10-year period. METHODS We retrospectively reviewed result of 200 Endoscopic thoracic sympathotomy surgeries that was performed in a single center to treat craniofacial, palmar, or axillary primary hyperhidrosis over a 10-year period. Patients were asked to report success of surgery to resolve their primary hyperhidrosis, development of compensatory hyperhidrosis, its severity, and their overall satisfaction with surgery. RESULTS Palmar hyperhidrosis was resolved in 167 (94%) patients. Craniofacial hyperhidrosis was resolved in 66 (84%) patients. Axillary hyperhidrosis was resolved in 68 (50%) patients. Compensatory hyperhidrosis developed in 176 (88%) patients. 44 (22%) patients had mild CHH, 79 (40%) patients developed moderate CHH, and 52 (26%) patients experienced severe CHH. A total of 173 (87%) patients were satisfied with surgery. 19 (9%) patients were not satisfied with ETS and 8 (4%) patients regretted ETS. Lower body mass index and grade IV primary hyperhidrosis were found to be independent predictors of patient satisfaction. Pure axillary primary hyperhidrosis was a negative predictor of patient satisfaction. CONCLUSION Best results of ETS are achieved in patients with grade IV PHH and lower body mass indexes. Outcome of ETS for treating axillary PHH is not favorable.
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Affiliation(s)
- Karamollah Toolabi
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.,Department of Surgery, Erfan Hospital, Tehran, Iran
| | - Reza Parsaei
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Surgery, Erfan Hospital, Tehran, Iran.
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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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Nicolini EM, Costa VDO, Montessi J, Rodrigues GDA, Cangussu VV, Reis AFM, Marques Filho FV. Video-assisted thoracic sympathectomy: literature review. Rev Col Bras Cir 2019; 46:e2157. [PMID: 31141034 DOI: 10.1590/0100-6991e-20192157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/12/2019] [Indexed: 11/22/2022] Open
Abstract
Thoracic sympathectomy has been effective in relieving hyperhidrosis in several patients, with quality of life improvement. The knowledge of the clinical picture of each patient, as well as the possible postoperative complications, are fundamental to obtain good results. Thus, we performed a review of articles from the PubMed database published between 2005 and 2019 that presented, as the main topic, thoracoscopy sympathectomy for the treatment of hyperhidrosis, with the objective of evaluating the current state of art referring to postoperative quality of life, surgical time and its complications. From this analysis, we verified the importance of the level of sympathetic ganglion chain section in relation to results. The complication, although occurring, did not reduced the postoperative level of satisfaction or patients' quality of life.
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Affiliation(s)
- Eveline Montessi Nicolini
- Hospital e Maternidade Therezinha de Jesus, Serviço de Cirurgia Torácica, Juiz de Fora, MG, Brasil.,Hospital Monte Sinai, Serviço de Cirurgia Torácica, Juiz de Fora, MG, Brasil
| | - Víctor de Oliveira Costa
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Curso de Medicina, Juiz de Fora, MG, Brasil
| | - Jorge Montessi
- Hospital e Maternidade Therezinha de Jesus, Serviço de Cirurgia Torácica, Juiz de Fora, MG, Brasil.,Hospital Monte Sinai, Serviço de Cirurgia Torácica, Juiz de Fora, MG, Brasil
| | - Guilherme de Abreu Rodrigues
- Hospital e Maternidade Therezinha de Jesus, Serviço de Cirurgia Torácica, Juiz de Fora, MG, Brasil.,Hospital Monte Sinai, Serviço de Cirurgia Torácica, Juiz de Fora, MG, Brasil
| | | | - Ana Flávia Miranda Reis
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Curso de Medicina, Juiz de Fora, MG, Brasil
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Wade R, Rice S, Llewellyn A, Moloney E, Jones-Diette J, Stoniute J, Wright K, Layton AM, Levell NJ, Stansby G, Craig D, Woolacott N. Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis. Health Technol Assess 2019; 21:1-280. [PMID: 29271741 DOI: 10.3310/hta21800] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable. OBJECTIVE To establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care. METHODS A systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only. RESULTS AND CONCLUSIONS Fifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life. LIMITATIONS The evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla. FUTURE WORK Based on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses. STUDY REGISTRATION This study is registered as PROSPERO CRD42015027803. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Ros Wade
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Stephen Rice
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Alexis Llewellyn
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Eoin Moloney
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Julija Stoniute
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Nick J Levell
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Gerard Stansby
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Dawn Craig
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nerys Woolacott
- Centre for Reviews and Dissemination, University of York, York, UK
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Leiderman DBD, Milanez de Campos JR, Kauffman P, Tedde ML, Yazbek G, Teivelis MP, Wolosker N. The relation between age and outcomes of thoracic sympathectomy for hyperhidrosis: The older the better. J Thorac Cardiovasc Surg 2018; 156:1748-1756. [PMID: 30054140 DOI: 10.1016/j.jtcvs.2018.05.084] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 05/07/2018] [Accepted: 05/09/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Several factors may potentially influence the efficacy and patient satisfaction after bilateral thoracic sympathectomy as the treatment for hyperhidrosis, but few studies have specifically analyzed the impact of age on the efficacy of this treatment, the occurrence of compensatory hyperhidrosis (CH), and variations in the quality of life. METHODS We retrospectively analyzed the effect of age, body mass index, surgical techniques, quality of life before surgery, betterment in the quality of life after surgery, clinical improvement in sweating at the main site, and the occurrence and intensity of CH in patients with hyperhidrosis (n = 1633) who underwent bilateral sympathectomy. RESULTS Quality of life improved in more than 90% of patients, and severe CH occurred in 5.4%. Age did not affect these outcomes. The older, the greater reduction in sweating, and CH was linked to other variables (body mass index, craniofacial hyperhidrosis, and level of resection). CONCLUSIONS We observed that patients with old age reported an improvement in sweating in the main site of hyperhidrosis. Sympathectomy outcomes in older patients are similar to those observed in younger patients in terms of quality of life improvement and occurrence of CH.
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Affiliation(s)
| | - Jose Ribas Milanez de Campos
- Division of Thoracic Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil; Thoracic Surgery Division, Department of Surgery, University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
| | - Paulo Kauffman
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil; Vascular and Endovascular Division, Department of Surgery, University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
| | - Miguel Lia Tedde
- Thoracic Surgery Division, Department of Surgery, University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
| | - Guilherme Yazbek
- Department of Vascular and Endovascular Surgery, A.C. Camargo Cancer Center, Fundação Antônio Prudente, São Paulo, São Paulo, Brazil
| | - Marcelo Passos Teivelis
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Nelson Wolosker
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil; Vascular and Endovascular Division, Department of Surgery, University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
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Felisberto Júnior G, Rubira CJ, Berumudes JPS, Bueno DA-Silveira-Júnior S. Comparison between high and low levels thoracic sympathectomy for the treatment of palmar and axillary primary hyperhidrosis: systematic review and meta-analysis. Rev Col Bras Cir 2018; 43:486-492. [PMID: 28273218 DOI: 10.1590/0100-69912016006009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 09/26/2016] [Indexed: 11/21/2022] Open
Abstract
Primary hyperhidrosis (PH) is a condition that has a great impact on affected individuals' quality of life, regardless of its location. Its surgical treatment is done through thoracic sympathectomy performed by videothoracoscopy. Standardization of the technique includes section of the sympathetic trunk at different levels, according to the site of symptoms. The aim of this review is to evaluate the efficacy of thoracic sympathectomy through a systematic literature review comparing sympathectomy at different levels of the sympathetic chain.
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Affiliation(s)
| | - Cláudio José Rubira
- Department of Thoracic Surgery, University of Marília, Marília, São Paulo, Brazil
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10
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Retroperitoneoscopic lumbar sympathectomy for plantar hyperhidrosis. J Vasc Surg 2017; 66:1806-1813. [PMID: 29169540 DOI: 10.1016/j.jvs.2017.05.126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 05/18/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to assess the reduction in quality of life (QoL) caused by the persistence of primary plantar hyperhidrosis (PPH) symptoms and the level of satisfaction in PPH patients after retroperitoneoscopic lumbar sympathectomy (RLS). The efficacy, safety, and procedure of bilateral RLS in both sexes are also described in this study. METHODS This is a longitudinal study of consecutive patients who sought specific treatment from a private practitioner for severe PPH as classified on the Hyperhidrosis Disease Severity Scale (HDSS) from October 2005 to October 2014. The patients were asked to report the symptoms of PPH experienced in the immediate preoperative period and to complete a standardized QoL questionnaire developed by de Campos at least 12 months after RLS. Disease outcomes, recurrence of symptoms, and any adverse effects of surgery were evaluated after 30 days and at least 12 months after RLS. RESULTS Lumbar sympathectomy was performed 116 times in 58 patients; 30 days after surgery, PPH was resolved in all patients. Three patients (5.2%) reported transient thigh neuralgia, and 19 (32.7%) reported transient paresthesia in the lower limbs. There were no reports of retrograde ejaculation. At a minimum of 12 months after RLS, 49 of the 58 patients had fully and correctly answered the follow-up questionnaire and noted a mild (HDSS 2) to moderate (HDSS 3) increase in pre-existing compensatory sweating. One patient had a PPH relapse within 6 months. Improvement in QoL due to the resolution of PPH was reported in 98% of the 49 patients. None of the operations necessitated a change in the laparotomy approach, and none of the patients died. CONCLUSIONS RLS is safe and effective for the treatment of severe PPH in both sexes. There were no reports of retrograde ejaculation after resection of L3 and L4 ganglia. There was a mild to moderate increase in compensatory sweating in about half of the patients, but without any regret or dissatisfaction for having undergone the surgery because of a significant improvement in QoL.
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11
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Sternbach JM, DeCamp MM. Targeting the Sympathetic Chain for Primary Hyperhidrosis. Thorac Surg Clin 2016; 26:407-420. [DOI: 10.1016/j.thorsurg.2016.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Webster G, Monge MC. Left Cardiac Sympathetic Denervation: Should We Sweat the Side Effects? Circ Arrhythm Electrophysiol 2016; 8:1007-9. [PMID: 26487619 DOI: 10.1161/circep.115.003413] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gregory Webster
- From the Divisions of Cardiology (G.W.) and Cardio-Thoracic Surgery (M.C.M.), Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, IL.
| | - Michael C Monge
- From the Divisions of Cardiology (G.W.) and Cardio-Thoracic Surgery (M.C.M.), Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, IL
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13
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Tulay CM. Sympathectomy for Palmar Hyperhidrosis. Indian J Surg 2016; 77:327-9. [PMID: 26730019 DOI: 10.1007/s12262-013-0822-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 01/15/2013] [Indexed: 11/30/2022] Open
Abstract
Palmar hyperhidrosis is an important situation that may cause emotional and work-related problems. Although local treatment and psychotherapy have been used for palmar hyperhidrosis, the choice of treatment for palmar hyperhidrosis is video-assisted thoracoscopic sympathectomy. Retrospective analysis of 120 bilateral thoracoscopic sympathectomies (60 patients) was done in this study. Earlier, 12 of 60 patients (20 %) had been operated on by other surgeons who used clipping method for palmar hyperhidrosis in different hospitals within 1 year. The procedure was performed under general anesthesia using single-lumen endotracheal tube. Sympathetic chain resection was performed between lower level of the second rib and upper level of the fourth rib. Intercostal blockage at three levels was performed, while thoracoscopic control of the injection sites was done. We observed improvement of symptoms in 95 %, mild compensatory sweating in 20 %, and excessive dryness of hands in 10 % in our patients.
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Affiliation(s)
- Cumhur Murat Tulay
- Department of Thoracic Surgery, Sanlıurfa Teaching and Research Hospital, Sanlıurfa, Turkey
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14
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Hashmonai M, Cameron AEP, Licht PB, Hensman C, Schick CH. Thoracic sympathectomy: a review of current indications. Surg Endosc 2015; 30:1255-69. [PMID: 26123342 DOI: 10.1007/s00464-015-4353-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 06/16/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Thoracic sympathetic ablation was introduced over a century ago. While some of the early indications have become obsolete, new ones have emerged. Sympathetic ablation is being still performed for some odd indications thus prompting the present study, which reviews the evidence base for current practice. METHODS The literature was reviewed using the PubMed/Medline Database, and pertinent articles regarding the indications for thoracic sympathectomy were retrieved and evaluated. Old, historical articles were also reviewed as required. RESULTS AND CONCLUSIONS Currently, thoracic sympathetic ablation is indicated mainly for primary hyperhidrosis, especially affecting the palm, and to a lesser degree, axilla and face, and for facial blushing. Despite modern pharmaceutical, endovascular and surgical treatments, sympathetic ablation has still a place in the treatment of very selected cases of angina, arrhythmias and cardiomyopathy. Thoracic sympathetic ablation is indicated in several painful conditions: the early stages of complex regional pain syndrome, erythromelalgia, and some pancreatic and other painful abdominal pathologies. Although ischaemia was historically the major indication for sympathetic ablation, its use has declined to a few selected cases of thromboangiitis obliterans (Buerger's disease), microemboli, primary Raynaud's phenomenon and Raynaud's phenomenon secondary to collagen diseases, paraneoplastic syndrome, frostbite and vibration syndrome. Thoracic sympathetic ablation for hypertension is obsolete, and direct endovascular renal sympathectomy still requires adequate clinical trials. There are rare publications of sympathetic ablation for primary phobias, but there is no scientific basis to support sympathetic surgery for any psychiatric indication.
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Affiliation(s)
- Moshe Hashmonai
- Faculty of Medicine, Technion-Israel Institute of Technology, PO Box 359, 30952119, Zikhron Ya'akov, Haifa, Israel.
| | | | - Peter B Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
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Cai SW, Shen N, Li DX, Wei B, An J, Zhang JH. Compensatory sweating after restricting or lowering the level of sympathectomy: a systematic review and meta-analysis. Clinics (Sao Paulo) 2015; 70:214-9. [PMID: 26017654 PMCID: PMC4449481 DOI: 10.6061/clinics/2015(03)11] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 01/05/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To compare compensatory sweating after lowering or restricting the level of sympathectomy. METHOD A systematic review and meta-analysis were conducted of all randomized controlled trials published in English that compared compensatory sweating after lowering or restricting the level of sympathectomy. The Cochrane collaboration tool was used to assess the risk of bias, and the Mantel-Haenszel odds ratio method was used for the meta-analysis. RESULTS A total of 11 randomized controlled trials were included, including a total of 1079 patients. Five of the randomized controlled trials studied restricting the level of sympathectomy, and the remaining six studied lowering the level of sympathectomy. CONCLUSIONS The compiled randomized controlled trial results published so far in the literature do not support the claims that lowering or restricting the level of sympathetic ablation results in less compensatory sweating.
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Affiliation(s)
- Song-Wang Cai
- Department of Cardiothoracic Surgery, Sun Yat-sen University, Guangzhou, China
| | - Ning Shen
- Department of Anesthesiology, Sun Yat-sen University, Guangzhou, China
| | - Dong-Xia Li
- School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, China
| | - Bo Wei
- Department of Gastrointestinal Surgery, Sun Yat-sen University, Guangzhou, China
| | - Jun An
- Department of Cardiothoracic Surgery, Sun Yat-sen University, Guangzhou, China
| | - Jun-Hang Zhang
- Department of Cardiothoracic Surgery, Sun Yat-sen University, Guangzhou, China
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Wolosker N, Krutman M, Teivelis MP, Paula RPD, Kauffman P, Campos JRMD, Puech-Leão P. Analysis of oxybutynin treatment for hyperhidrosis in patients aged over 40 years. EINSTEIN-SAO PAULO 2014; 12:42-7. [PMID: 24728245 PMCID: PMC4898238 DOI: 10.1590/s1679-45082014ao2841] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 11/06/2013] [Indexed: 11/21/2022] Open
Abstract
Objective: Our aim was to analyze the effectiveness of oxybutynin for hyperhidrosis treatment in patients over 40 years. Methods: Eighty-seven patients aged over 40 years were divided into two groups. One group consisted of 48 (55.2%) patients aged between 40 and 49 years, and another was composed of 39 (44.8%) patients aged over 50 years (50 to 74 years). A comparative analysis of Quality of Life and level of hyperhidrosis between the groups was carried out 6 weeks after a protocol treatment with oxybutynin. A validated clinical questionnaire was used for evaluation. Results: In the younger age group, 75% of patients referred a “partial” or “great” improvement in level of hyperhidrosis after treatment. This number was particularly impressive in patients over 50 years, in which 87.2% of the cases demonstrated similar levels of improvement. Over 77% of patients in both groups demonstrated improvement in Quality of Life. Excellent outcomes were observed in older patients, in which 87.1% of patients presented “slightly better” (41%) or “much better” (46.1%) improvement. Conclusion: Patients aged over 40 years with hyperhidrosis presented excellent results after oxybutynin treatment. These outcomes were particularly impressive in the age group over 50 years, in which most patients had significant improvement in Quality of Life and in level of hyperhidrosis.
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Affiliation(s)
| | | | | | | | - Paulo Kauffman
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Pedro Puech-Leão
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Wolosker N, Krutman M, Kauffman P, Paula RPD, Campos JRMD, Puech-Leão P. Effectiveness of oxybutynin for treatment of hyperhidrosis in overweight and obese patients. Rev Assoc Med Bras (1992) 2013; 59:143-7. [PMID: 23582555 DOI: 10.1016/j.ramb.2012.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 10/17/2012] [Accepted: 11/04/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Until the present moment, the lack of efficient therapeutic options available for hyperhidrosis treatment in obese patients has left this population without prospect of clinical or quality of life (QOL) improvements. Outcomes of oxybutynin treatment for overweight and obese patients with hyperhidrosis are unknown. This study aims to investigate the results related to clinical and QOL improvements in this specific population, submitted to a 12-week protocol treatment with oxybutynin. METHODS 559 patients with palmar and axillary hyperhidrosis, routinely followed in this service, were divided into the groups, according to their body mass index (BMI) (<25kg/m(2); 25 < BMI < 30kg/m(2), > 30kg/m(2)). Improvements in QOL and in the level of hyperhidrosis were analyzed after 12 weeks of protocol treatment with oxybutynin. These parameters were investigated using a scoring system based on a scientifically validated clinical questionnaire, applied before and after treatment. RESULTS 67.8% of the overweight sample group and 63% of the obese patients presented "partial" or "great" improvement in the level of hyperhidrosis. Over 65% of patients demonstrated improvement in QOL ("much better" or "slightly better") for all three groups, with no statistical difference between them. The only adverse event associated with oxybutynin was dry mouth, observed in 63.0% of the patients. CONCLUSION Overweight and obese patients with palmar or axillary hyperhidrosis present significant improvement in QOL after treatment with oxybutynin, and the results are comparable to those of normal weight individuals.
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Affiliation(s)
- Nelson Wolosker
- Division of Vascular Surgery, Hospital das Clínicas, Medical School, Universidade de São Paulo, São Paulo, SP, Brazil
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Sakiyama BYP, Monteiro TV, Ishy A, Campos JRMD, Kauffman P, Wolosker N. Quantitative assessment of the intensity of palmar and plantar sweating in patients with primary palmoplantar hyperhidrosis. J Bras Pneumol 2013; 38:573-8. [PMID: 23147049 DOI: 10.1590/s1806-37132012000500006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 07/13/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare individuals with and without hyperhidrosis in terms of the intensity of palmar and plantar sweating. METHODS We selected 50 patients clinically diagnosed with palmoplantar hyperhidrosis and 25 normal individuals as controls. We quantified sweating using a portable noninvasive electronic device that has relative humidity and temperature sensors to measure transepidermal water loss. All of the individuals had a body mass index of 20-25 kg/cm². Subjects remained at rest for 20-30 min before the measurements in order to reduce external interference. The measurements were carried out in a climate-controlled environment (21-24ºC). Measurements were carried out on the hypothenar region on both hands and on the medial plantar region on both feet. RESULTS In the palmoplantar hyperhidrosis group, the mean transepidermal water loss on the hands and feet was 133.6 ± 51.0 g/m²/h and 71.8 ± 40.3 g/m²/h, respectively, compared with 37.9 ± 18.4 g/m²/h and 27.6 ± 14.3 g/m²/h, respectively, in the control group. The differences between the groups were statistically significant (p < 0.001 for hands and feet). CONCLUSIONS This method proved to be an accurate and reliable tool to quantify palmar and plantar sweating when performed by a trained and qualified professional.
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Yuncu G, Turk F, Ozturk G, Atinkaya C. Comparison of only T3 and T3-T4 sympathectomy for axillary hyperhidrosis regarding treatment effect and compensatory sweating. Interact Cardiovasc Thorac Surg 2013; 17:263-7. [PMID: 23644731 DOI: 10.1093/icvts/ivt160] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Patients diagnosed with axillary hyperhidrosis can face psychosocial issues that can ultimately hinder their quality of life both privately and socially. The routine treatment for axillary hyperhidrosis is T3-T4 sympathectomy, but compensatory sweating is a serious side effect that is commonly seen with this approach. This study was designed to evaluate whether a T3 sympathectomy was effective for the treatment of axillary hyperhidrosis and whether this treatment led to less compensatory sweating than T3-T4 sympathectomies among our 60-patient population. METHODS One hundred and twenty endoscopic thoracic sympathectomies were performed on 60 patients who had axillary hyperhidrosis. The sympathectomies were accomplished by means of a single-lumen endotracheal tube and a single port. The axillary hyperhidrosis patients were randomly divided into two groups with 17 patients in Group 1 undergoing T3-T4 sympathectomies and 43 in Group 2 undergoing only T3 sympathectomies. We analysed the data associated with the resolution of axillary hyperhidrosis, the degree of patient satisfaction with the surgical outcome and the quality of life in parallel with compensatory sweating after the procedure as reported by the patient and confirmed by the examiner. Moreover, the results were compared statistically. RESULTS No statistically significant difference was observed between the groups based on age (P=0.56), gender (P=0.81), duration of the surgery (P=0.35) or postoperative satisfaction levels (P=0.45). However, the incidence and degree of compensatory sweating were lower in the T3 group than the T3-T4 group at the 1-year follow-up (P=0.008). CONCLUSIONS T3 sympathectomy was as effective as T3-T4 sympathectomy for the treatment of axillary hyperhidrosis based on the patients' reported postoperative satisfaction, and the T3 group demonstrated lower compensatory sweating at the 1-year follow-up.
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Affiliation(s)
- Gökhan Yuncu
- Department of Thoracic Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
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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.
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Wolosker N, Ishy A, Yazbek G, Campos JRMD, Kauffman P, Puech-Leão P, Jatene FB. Objective evaluation of plantar hyperhidrosis after sympathectomy. Clinics (Sao Paulo) 2013; 68:311-5. [PMID: 23644849 PMCID: PMC3611758 DOI: 10.6061/clinics/2013(03)oa05] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 11/07/2012] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The aim of the present study was to prospectively, randomly, blindly, and objectively investigate how surgery affects plantar sudoresis in patients with palmar and plantar hyperhidrosis over a one-year period using a sudorometer (VapoMeter). METHODS From February 2007 to May 2009, 40 consecutive patients with combined palmar hyperhidrosis and plantar hyperhidrosis underwent video-assisted thoracic sympathectomy at the T3 or T4 ganglion level (15 women and 25 men, with a mean age of 25 years). RESULTS Immediately after the operation and during the one-year follow-up, all of the patients were free from palmar hyperhidrosis episodes. Compensatory hyperhidrosis of varying degrees was observed in 35 (87.5%) patients after one year. Only two (2.5%) patients suffered from severe compensatory hyperhidrosis. There was a large initial improvement in plantar hyperhidrosis in 46.25% of the cases, followed by a progressive regression of that improvement, such that only 30% continued to show this improvement after one year. The proportion of patients whose condition worsened increased progressively (from 21.25% to 47.50%), and the proportion of stable patients decreased (32.5% to 22.50%). This was not related to resection level; however, a lower intensity of plantar hyperhidrosis prior to sympathectomy correlated with worse evolution. CONCLUSION Patients with palmar hyperhidrosis and plantar hyperhidrosis who underwent video-assisted thoracic sympathectomy to treat their palmar hyperhidrosis exhibited good initial improvement in plantar hyperhidrosis, which then decreased to lesser degrees of improvement over a one-year period following the surgery. For this reason, video-assisted thoracic sympathectomy should not be performed when only plantar hyperhidrosis is present.
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Affiliation(s)
- Nelson Wolosker
- Division of Vascular and Endovascular Surgery, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Wolosker N, Krutman M, Campdell TPDA, Kauffman P, Campos JRMD, Puech-Leão P. Oxybutynin treatment for hyperhidrosis: a comparative analysis between genders. EINSTEIN-SAO PAULO 2012; 10:405-8. [DOI: 10.1590/s1679-45082012000400002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 11/20/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To assess the results of palmar and axillary hyperhidrosis treatment in males and females using low doses of oxybutynin. METHODS: A retrospective analysis was conducted in 395 women and 170 men followed up in our service with complaint of palmar and axillary hyperhidrosis. RESULTS: A total of 70% of patients in both groups presented partial or great improvement in the level of hyperhidrosis after treatment. The best results were obtained in the female group, in which 40% classified their improvement as "great". Approximately 70% of the patients in both groups improved their quality of life after medical therapy and 30% presented no change in condition. CONCLUSION: Gender is not a factor that significantly interferes in oxybutynin treatment results. Quality of life indices and clinical improvement level were similar in men and women.
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Neves S, Uchoa PC, Wolosker N, Munia MA, Kauffman P, de Campos JRM, Puech-Leão P. Long-term comparison of video-assisted thoracic sympathectomy and clinical observation for the treatment of palmar hyperhidrosis in children younger than 14. Pediatr Dermatol 2012; 29:575-9. [PMID: 22486301 DOI: 10.1111/j.1525-1470.2012.01751.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The results of video-assisted thoracic sympathectomy (VATS)in children are unknown. To investigate the improvement in quality of life (QOL) of a group of 45 children who did and did not undergo VATS for the treatment of palmar hyperhidrosis (PH) 4 years after the initial evaluation. Forty-five children with PH were initially evaluated. Children were divided into two groups: 30 in the VATS group and 15 in the control group. We studied the evolution of PH, negative effect of hyperhidrosis on the QOL before the treatment, and improvement in QOL after treatment. Twenty-five patients (83.4%) in the VATS group experienced great improvement in PH, and five (16.6%) experienced partial improvement; 12 (80.0%) children from the control group had some type of improvement, and three (20.0%) had partial improvement. Two (13.3%) children in the control group and 23 (76.7%) in the VATS group had great improvement in QOL. For children with PH and poor QOL, VATS is better than no treatment. It produces better results with regard to sweating and greater improvement in QOL.
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Affiliation(s)
- Samantha Neves
- Division of Vascular Surgery, Hospital das Clínicas, University of São Paulo Medical School, Sao Paulo, Brazil
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Campos JRMD, Wolosker N, Munia MAS, Yazbek G, Kauffman P, Puech-Leão P, Jatene FB. Is age group a predictive factor for satisfaction among patients undergoing sympathectomy to treat hyperhidrosis? J Vasc Bras 2011. [DOI: 10.1590/s1677-54492011000400004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: Video-assisted thoracic sympathectomy is currently the procedure of choice for the definitive treatment of primary hyperhidrosis, because it is an effective, safe, and minimally invasive method. In the search for better quality of life indexes, all researchers look for predictive factors indicating better surgical outcomes. Failure in the primary treatment, postoperative compensatory hyperhidrosis, body mass index over 25, level of resection of the sympathetic chain, and extent of resection are some of the factors that may negatively influence the results. The objective of this study was to compare, according to the age group, the quality of life after bilateral thoracic sympathectomy for treatment of primary hyperhidrosis in a cohort of 1,644 patients. METHODS: From February 2000 to October 2008, data were collected from 1,644 patients with palmar (71%) or axillary (29%) hyperhidrosis who underwent video-assisted thoracic sympathectomy. The patients were divided into three groups according to their ages. The first group consisted of patients up to 17 years-old, the second from 18 to 30 years-old, and the third of over 30 years-old. All patients had a body mass index of less than 25. RESULTS: In the evaluation 30 days after surgery, improvement of the quality of life in the three groups was observed. There was no significant difference between the age groups. In the present study, 91.9% of the patients presented compensatory hyperhidrosis, with no difference between the age groups. CONCLUSIONS: Patients with primary hyperhidrosis experience quality of life improvement after thoracic sympathectomy regardless of their age.
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Kauffman P, Campos JRMD. Video-assisted thoracic sympathectomy for the treatment of axillary hyperhidrosis. J Bras Pneumol 2011; 37:4-5. [PMID: 21390425 DOI: 10.1590/s1806-37132011000100002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Boscardim PCB, Oliveira RAD, Oliveira AAFRD, Souza JMD, Carvalho RGD. Thoracic sympathectomy at the level of the fourth and fifth ribs for the treatment of axillary hyperhidrosis. J Bras Pneumol 2011; 37:6-12. [PMID: 21390426 DOI: 10.1590/s1806-37132011000100003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 11/05/2010] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE To describe the clinical results and the degree of satisfaction of patients submitted to thoracic sympathectomy at the level of the fourth and fifth ribs (R4-R5) for the treatment of axillary hyperhidrosis. METHODS We included 118 patients diagnosed with axillary hyperhidrosis and having undergone axillary sympathectomy at the R4-R5 level between March of 2003 and December of 2007 at the Paraná Federal University Hospital de Clínicas, located in the city of Curitiba, Brazil. All procedures were carried out by the same surgeon. Data regarding the resolution of axillary hyperhidrosis and the degree of patient satisfaction with the surgical outcome, as well as compensatory hyperhidrosis in the early and late postoperative periods (after 7 days and after 12 months, respectively), were collected. RESULTS Of the 118 patients evaluated, 99 (83.9%) and 81 (68.6%) showed complete resolution of the symptoms in the early and late postoperative periods, respectively. Compensatory hyperhidrosis occurred in 49 patients (41.5%) in the early postoperative period and in 77 (65.2%) in the late postoperative period. Of those 77, 55 (71.4%) categorized the compensatory hyperhidrosis as mild. In the early postoperative period, 110 patients (93.2%) were satisfied with the surgical results, and 104 (88.1%) remained so in the late postoperative period. CONCLUSIONS Sympathectomy at the R4-R5 level is efficient in the resolution of primary axillary hyperhidrosis. The degree of patient satisfaction with the long-term surgical results is high. Mild compensatory hyperhidrosis is the main side effect associated with this technique.
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The Use of Oxybutynin for Treating Axillary Hyperhidrosis. Ann Vasc Surg 2011; 25:1057-62. [DOI: 10.1016/j.avsg.2011.06.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 05/24/2011] [Accepted: 06/03/2011] [Indexed: 11/17/2022]
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Cerfolio RJ, De Campos JRM, Bryant AS, Connery CP, Miller DL, DeCamp MM, McKenna RJ, Krasna MJ. The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg 2011; 91:1642-8. [PMID: 21524489 DOI: 10.1016/j.athoracsur.2011.01.105] [Citation(s) in RCA: 215] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 12/29/2010] [Accepted: 01/11/2011] [Indexed: 11/29/2022]
Abstract
Significant controversies surround the optimal treatment of primary hyperhidrosis of the hands, axillae, feet, and face. The world's literature on hyperhidrosis from 1991 to 2009 was obtained through PubMed. There were 1,097 published articles, of which 102 were clinical trials. Twelve were randomized clinical trials and 90 were nonrandomized comparative studies. After review and discussion by task force members of The Society of Thoracic Surgeons' General Thoracic Workforce, expert consensus was reached from which specific treatment strategies are suggested. These studies suggest that primary hyperhidrosis of the extremities, axillae or face is best treated by endoscopic thoracic sympathectomy (ETS). Interruption of the sympathetic chain can be achieved either by electrocautery or clipping. An international nomenclature should be adopted that refers to the rib levels (R) instead of the vertebral level at which the nerve is interrupted, and how the chain is interrupted, along with systematic pre and postoperative assessments of sweating pattern, intensity and quality-of-life. The recent body of literature suggests that the highest success rates occur when interruption is performed at the top of R3 or the top of R4 for palmar-only hyperhidrosis. R4 may offer a lower incidence of compensatory hyperhidrosis but moister hands. For palmar and axillary, palmar, axillary and pedal and for axillary-only hyperhidrosis interruptions at R4 and R5 are recommended. The top of R3 is best for craniofacial hyperhidrosis.
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Affiliation(s)
- Robert J Cerfolio
- Division of Thoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
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Wolosker N, Munia MAS, Kauffman P, de Campos JRM, Yazbek G, Puech-Leão P. Is gender a predictive factor for satisfaction among patients undergoing sympathectomy to treat palmar hyperhidrosis? Clinics (Sao Paulo) 2010; 65:583-6. [PMID: 20613933 PMCID: PMC2898554 DOI: 10.1590/s1807-59322010000600004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 03/08/2010] [Accepted: 03/15/2010] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED Video-assisted thoracic sympathectomy (VATS) is currently the procedure of choice for the definitive treatment of primary hyperhidrosis because it is an effective, safe, and minimally invasive method. The aim of VATS treatment is to improve the quality of life through the reduction of excessive sudoresis. The purpose of this study was to assess the quality of life after VATS for treating palmar hyperhidrosis according to gender. METHODS A total of 1044 patients who submitted to the surgical treatment for palmar hyperhidrosis from June 2000 to February 2008 were retrospectively evaluated. The patients were divided into two groups according to gender [719 (68.8%) females and 325 (31.2%) males]. RESULTS There are no statistically significant differences between genders with regard to the quality of life in palmar hyperhidrosis patients (p = 0.726). In the interview that was performed 30 days after surgery, the quality of life in the two groups had improved, with no statistical difference between the groups. CONCLUSION Patients with palmar hyperhidrosis present with an improvement in the quality of life after VATS regardless of gender.
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Wolosker N, Yazbek G, de Campos JRM, Munia MA, Kauffman P, Jatene FB, Puech-Leao P. Quality of life before surgery is a predictive factor for satisfaction among patients undergoing sympathectomy to treat hyperhidrosis. J Vasc Surg 2010; 51:1190-4. [PMID: 20299178 DOI: 10.1016/j.jvs.2009.11.078] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Revised: 11/16/2009] [Accepted: 11/16/2009] [Indexed: 11/18/2022]
Abstract
PURPOSE The objective of this study was to evaluate the postoperative quality of life (QOL) experienced among a group of 1167 patients who underwent video-assisted thoracoscopic sympathectomy (VATS) to treat primary hyperhidrosis, as compared with the presurgical QOL. METHODS Between February 2002 and June 2007, 1167 patients who had undergone VATS were surveyed. The majority had presented with palmar hyperhidrosis (794 patients; 68%), while 340 (29%) had presented with axillary hyperhidrosis. Based on data obtained from the QOL protocol applied to all of the patients preoperatively, the patients were divided into two groups according to the level of their QOL: group 1 consisted of 312 patients (27%) with poor QOL and group 2 of 855 patients (73%) with very poor QOL. The same protocol was applied postoperatively, and five different levels of satisfaction were obtained. The same parameters were evaluated for both the palmar and the axillary hyperhidrosis subgroups. RESULTS The patients with very poor QOL had much better results in terms of improvement in QOL than did those with poor QOL (P < .05). The same result was observed for both the palmar and axillary hyperhidrosis subgroups (P < .05). CONCLUSION The worse the preoperative QOL among patients undergoing sympathectomy to treat primary hyperhidrosis is, the better the postoperative improvement in QOL will be.
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Affiliation(s)
- Nelson Wolosker
- Department of Vascular Surgery, Hospital das Clínicas, Heart Institute (Incor), University of São Paulo Medical School, São Paulo, Brazil.
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de Campos JRM, Wolosker N, Yazbek G, Munia MA, Kauffman P, Puech-Leao P, Jatene FB. Comparison of pain severity following video-assisted thoracoscopic sympathectomy: electric versus harmonic scalpels. Interact Cardiovasc Thorac Surg 2010; 10:919-22. [PMID: 20233806 DOI: 10.1510/icvts.2009.225383] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to compare the severity of pain over a 30-day period in a group of 1515 patients who underwent video-assisted thoracoscopic sympathectomy (VATS) to treat primary hyperhidrosis, among whom 929 were treated using electric scalpels and 586 using harmonic scalpels. From February 2000 to June 2008, 1515 patients scheduled for VATS were prospectively surveyed. They were divided into two groups according to whether electric or harmonic scalpels would be used. The patients filled out a protocol at every visit according to their subjective perception of pain, evaluating it on a scale from 0 to 10, such that 0 represented no pain and 10, maximum pain. The severity was recorded as null when the score was 0; slight, 1-4; moderate, 5-7; or severe, 8-10. The results from the evaluations were compared between the two groups. Only 152 patients did not present postoperative pain. No significant association was found between the type of scalpel used and the severity of the pain. There was no difference between harmonic and electric scalpel use in the levels of thoracic pain during the first 30 days after VATS.
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Affiliation(s)
- José Ribas Milanez de Campos
- Department of Thoracic Surgery, Hospital das Clínicas, Heart Institute (Incor), University of São Paulo Medical School, São Paulo, Brazil.
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Yazbek G, Wolosker N, Kauffman P, Campos JRMD, Puech-Leão P, Jatene FB. Twenty months of evolution following sympathectomy on patients with palmar hyperhidrosis: sympathectomy at the T3 level is better than at the T2 level. Clinics (Sao Paulo) 2009; 64:743-9. [PMID: 19690657 PMCID: PMC2728186 DOI: 10.1590/s1807-59322009000800006] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 05/04/2009] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To compare two surgical techniques (denervation levels) for sympathectomy using video-assisted thoracoscopy to treat palmar hyperhidrosis in the long-term. METHODS From May 2003 to June 2006, 60 patients with palmar hyperhidrosis were prospectively randomized for video-assisted thoracoscopic sympathectomy at the T2 or T3 ganglion level. They were followed for a mean of 20 months and were evaluated regarding their degree of improvement of palmar hyperhidrosis, incidence and severity of compensatory hyperhidrosis and its evolution over time, and quality of life. RESULTS Fifty-nine cases presented resolution of the palmar hyperhidrosis. One case of therapeutic failure occurred in the T3 group. Most of the patients presented an improvement in palmar hyperhidrosis, without any difference between the groups. Twenty months later, all patients in both groups presented some degree of compensatory hyperhidrosis but with less severity in the T3 group (p = 0.007). Compensatory hyperhidrosis developed in most patients during the first month after the operation, with incidence and severity that remained stable over time. An improvement in quality of life was seen starting from the first postoperative evaluation but without any difference between the groups. This improvement was maintained until the end of the follow-up. CONCLUSION Both techniques were effective for treating palmar hyperhidrosis. The most frequent complication was compensatory hyperhidrosis, which presented stable incidence and severity over the study period. Sympathectomy at the T3 level presented compensatory hyperhidrosis with less severity. Nevertheless, the improvement in quality of life was similar between the groups.
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Affiliation(s)
- Guilherme Yazbek
- Department of Vascular Surgery, Hospital das Clínicas, Faculdade de Medicinada Universidade de São Paulo, São Paulo/SP, Brazil.
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