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Masarwa H, Salama N, Turk A, Abuawad M, Hawari A, Ziyadeh J, Al Zabadi H. Incidence and Severity of Compensatory Hyperhidrosis Following Bilateral Sympathectomy. Ann Vasc Surg 2024; 108:317-324. [PMID: 39002894 DOI: 10.1016/j.avsg.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 04/28/2024] [Accepted: 05/09/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Primary hyperhidrosis is a condition caused by an excessive stimulation of sweat glands, leading to a decline in both quality of life and social wellbeing. Thoracic sympathectomy surgery provides a relief of the initial symptoms but poses a risk for developing compensatory hyperhidrosis (CH) in various degrees. OBJECTIVE The aim of this study was to assess the occurrence and characteristics of CH post-thoracic sympathectomy. METHODS A retrospective cohort study of patients who underwent video-assisted thoracic sympathectomy surgery at level T2-T3 between 2016 and 2022 was conducted. Patients' data were retrieved from medical records and through a telephone interview. RESULTS A total of 50 patients (32 males and 18 females) were operated on with a mean ± standard deviation (SD) age of 25.9 ± 7.4 years at the time of surgery for palmoplantar hyperhidrosis. Initial symptoms started in childhood at a mean ± SD age of 11.4 ± 3.3 years. Postoperatively, 39 patients (78%) developed CH, more prevalent in males (64.1%) compared to females (35.8%). This CH mainly affected the back and abdomen (100%), followed by the groin and thighs (28.2%), and, to a lesser extent, the craniofacial area (15.3%). Onset of symptoms occurred within 1 week after surgery in 71.7% of cases, with 71.7% reporting mild to moderate symptoms. CH was significantly associated with higher age at the time of surgery, smoking status, and a longer time lapse in the surgery operation (P value < 0.05). CONCLUSIONS Thoracic sympathectomy is an effective procedure with a high success rate. Despite a relatively higher occurrence of CH, most patients experience milder symptoms and express satisfaction, noting that their expectations were met following the surgery.
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Affiliation(s)
- Hanaa Masarwa
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Nahar Salama
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Abdullah Turk
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mohammad Abuawad
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
| | - Abdallah Hawari
- General and minimally invasive surgeon, Hepato-biliary and pancreatic surgeon, An-Najah National University, Nablus, Palestine
| | - Jawad Ziyadeh
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; Department of Neurosurgery, An-Najah National University Hospital, Nablus, Palestine
| | - Hamzeh Al Zabadi
- Public Health Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Fan H, Xu P, Zhang E, Meng X, Xia J, Fei Y, Yao M. Risk Factors Affecting the Outcomes of CT-Guided Radiofrequency Thermocoagulation of the T3 Sympathetic Nerve in the Treatment of Craniofacial Hyperhidrosis. Ther Clin Risk Manag 2024; 20:465-472. [PMID: 39131182 PMCID: PMC11314434 DOI: 10.2147/tcrm.s463025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 07/14/2024] [Indexed: 08/13/2024] Open
Abstract
Background Current studies mostly suggest that hyperhidrosis is caused by relative sympathetic hyperactivity. Sympathetic radiofrequency thermocoagulation is widely used in clinics. Previous studies have demonstrated that surgery at T3 is effective and safe compared with higher levels, so craniofacial hyperhidrosis in our hospital is selected to be treated at T3. However, some patients pursue repeat medical treatment due to an increase in hyperhidrosis at the original site after surgery. Previous studies have demonstrated the significance of Perfusion index (PI) value in the recurrence of palmar hyperhidrosis, but there is no relevant study on craniofacial hyperhidrosis. Methods Clinical data from patients with craniofacial hyperhidrosis, who underwent T3 sympathetic radiofrequency thermocoagulation at Jiaxing First Hospital (Jiaxing, China) between January 1, 2018 and December 31, 2021, were analyzed. Recurrence in patients 1 year after surgery was recorded through a case search and telephone follow-up system that registered patient information. Clinical data were analyzed using binary logistic regression analysis to investigate risk factors associated with recurrence in patients with craniofacial hyperhidrosis 1 year after surgery. Results Of 83 patients included in the present study, 34 (40%) experienced increased craniofacial sweating 1 year after surgery. Results of univariate logistic regression analysis revealed that computed tomography (CT) scan count, increase in pulse index (PI) at the fingertips, and differences in forehead temperature were potential risk factors for postoperative recurrence in patients with craniofacial hyperhidrosis (p<0.2), and the results were consistent on both sides. Three potential risk factors were included in the multivariate logistic regression analysis and results revealed that the risk for recurrence was reduced by 48% (left side) and 67% (right side) for every 1 unit increase in PI value. Conclusion A small increase in PI was an independent risk factor for recurrence of hyperhidrosis in patients with craniofacial hyperhidrosis after undergoing T3 sympathetic radiofrequency thermocoagulation.
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Affiliation(s)
- Hanrui Fan
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Ping Xu
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Enming Zhang
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Xi Meng
- Zhejiang Sci-Tech University, Hangzhou, Zhejiang, People’s Republic of China
| | - Jianmei Xia
- Department of Anesthesiology and Pain, The First Hospital of Jiaxing, Jiaxing, Zhejiang, People’s Republic of China
| | - Yong Fei
- Department of Anesthesiology and Pain, The First Hospital of Jiaxing, Jiaxing, Zhejiang, People’s Republic of China
| | - Ming Yao
- Department of Anesthesiology and Pain, The First Hospital of Jiaxing, Jiaxing, Zhejiang, People’s Republic of China
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Vaid Z. Unilateral Sweating: A Case Study of Localized Unilateral Hyperhidrosis. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S2978-S2980. [PMID: 39346186 PMCID: PMC11426731 DOI: 10.4103/jpbs.jpbs_125_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 10/01/2024] Open
Abstract
Localized unilateral hyperhidrosis (LUH) is a rare disorder with intense sweating in a specific area, often without common triggers. This study details a 32-year-old man with activity-induced unilateral sweating. Comprehensive tests ruled out serious conditions. This unique case adds to the limited reports of LUH in healthy individuals.
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Affiliation(s)
- Zubin Vaid
- Nanavati Max Super Speciality Hospital, LIC Colony, Suresh Colony, Vile Parle West, Mumbai, Maharashtra, India
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Lee HJ, Kang JJ, Oh SY. Persistent Horner Syndrome Following Bilateral Endoscopic Thoracic Sympathotomy: A Case Report. Neuroophthalmology 2024; 48:364-368. [PMID: 39145325 PMCID: PMC11321419 DOI: 10.1080/01658107.2024.2324397] [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: 12/19/2023] [Revised: 02/12/2024] [Accepted: 02/24/2024] [Indexed: 08/16/2024] Open
Abstract
Horner syndrome, manifesting as ptosis and miosis, arises from disruptions within the oculosympathetic pathway. This syndrome is classified based on the lesion's location along the sympathetic nerve pathway into central, preganglionic, or postganglionic types. While endoscopic transthoracic sympathectomy, a surgical intervention for hyperhidrosis, is associated with several complications, including compensatory hyperhidrosis, Horner syndrome, and pneumothorax, these complications are notably rarer in sympathotomy procedures. Importantly, the incidence of Horner syndrome post-operatively is notably low, particularly in comparison to compensatory hyperhidrosis, with most cases being reversible and not necessitating further intervention. This report delineates a rare case of persistent Horner syndrome following a bilateral sympathotomy at the T3 and L3 levels, performed to alleviate symptoms of palmar and plantar hyperhidrosis. The discussion underscores the rarity of such a complication and explores the implications for surgical practice and patient counselling.
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Affiliation(s)
- Hyun-Jin Lee
- Department of Neurology, Jeonbuk National University Hospital, Jeonbuk National University School of Medicine, Jeonju, Korea
| | - Jin-Ju Kang
- Department of Neurology, Jeonbuk National University Hospital, Jeonbuk National University School of Medicine, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonbuk National University Hospital, Jeonju, Korea
| | - Sun-Young Oh
- Department of Neurology, Jeonbuk National University Hospital, Jeonbuk National University School of Medicine, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonbuk National University Hospital, Jeonju, Korea
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Prodan-Barbulescu C, Castiglione L, Burtic SR, Murariu M, Reddy S, Rosca O, Bratosin F, Melania Fizedean C, Krupyshev P, Enatescu I. Longitudinal Assessment of Facial Hyperhidrosis Management: Evaluating the Utility and Quality of Life Improvements following Botulinum Toxin Injection. Toxins (Basel) 2024; 16:59. [PMID: 38276535 PMCID: PMC10820190 DOI: 10.3390/toxins16010059] [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] [Received: 11/21/2023] [Revised: 01/15/2024] [Accepted: 01/20/2024] [Indexed: 01/27/2024] Open
Abstract
Facial hyperhidrosis is a debilitating condition that can severely impact the quality of life. This study aimed to assess the long-term utility of Botulinum toxin type A therapy (BTA) for facial hyperhidrosis and its impact on quality of life over a one-year period. Conducted at the Pius Brinzeu Clinical Emergency Hospital in Timisoara, Romania, this longitudinal observational study involved 77 adult patients with primary facial hyperhidrosis. Participants received two sessions of Botulinum toxin injections (50 U IncoBTX-A each) and were evaluated at baseline, 6 months, and 12 months using the Hyperhidrosis Disease Severity Scale (HDSS), WHOQOL-BREF, Dermatology Life Quality Index (DLQI), and a bespoke survey. The study demonstrated significant reductions in HDSS scores from 3.6 ± 0.5 to 1.2 ± 0.8 post-treatment, sustained at 1.3 ± 0.6 at 12 months (p-value < 0.001). DLQI scores markedly decreased from 24.8 ± 4.2 to 6.2 ± 2.1 post-treatment, stabilizing at 6.5 ± 2.5 at 12 months (p-value < 0.001). Sweat production significantly dropped from 0.75 g ± 0.15 to 0.18 g ± 0.07 per 15 min (p-value < 0.001). WHOQOL-BREF scores improved notably in the mental domain from 66.7 ± 6.1 to 70.8 ± 5.2 at 12 months (p-value < 0.001), with physical and social domains also showing significant improvements. Correlation analysis revealed strong negative correlations between DLQI total score and HDSS (rho = -0.72, p-value < 0.001) and sweat production (rho = -0.68, p-value < 0.001). Regression analysis indicated significant predictors for DLQI total score, including HDSS (B Coefficient = -3.8, p-value < 0.001) and sweat production (B Coefficient = -2.2, p-value < 0.001). BTA therapy significantly improved the quality of life in facial hyperhidrosis patients, with lasting effects on symptom severity, sweat production, and quality of life domains. The correlation and regression analyses further substantiated the treatment's impact on both physical and psychological aspects. These findings advocate Botulinum toxin as a viable long-term treatment for facial hyperhidrosis.
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Affiliation(s)
- Catalin Prodan-Barbulescu
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.P.-B.); (S.R.B.)
- IInd Surgery Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Department I-Discipline of Anatomy and Embryology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Luca Castiglione
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.P.-B.); (S.R.B.)
- Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Sonia Roxana Burtic
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.P.-B.); (S.R.B.)
- Research Center for Medical Communication, Victor Babes University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Marius Murariu
- Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Shruta Reddy
- Department of General Medicine, SVS Medical College, Yenugonda, Mahbubnagar 509001, Telangana, India;
| | - Ovidiu Rosca
- Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.R.); (F.B.)
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Felix Bratosin
- Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.R.); (F.B.)
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Camelia Melania Fizedean
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Pavel Krupyshev
- Faculty of General Medicine, I.M. Sechenov First Moscow State Medical University, Bolshaya Pirogovskaya Ulitsa 2, 119435 Moscow, Russia;
| | - Ileana Enatescu
- Department of Obstetrics and Gynecology, Discipline of Childcare and Neonatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
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Peetermans M, Vanlommel J, Van Look L, Uyttebroek L, Van Schil P, van Nassauw L. The anatomical variations of the additional communicating rami in the proximal sympathetic trunk: A human cadaveric study. TRANSLATIONAL RESEARCH IN ANATOMY 2023. [DOI: 10.1016/j.tria.2023.100240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
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Ravendran K, Babu B, Madouros N, Panagiotopoulos N. Robotic Sympathectomy for Hyperhidrosis. Cureus 2023; 15:e33885. [PMID: 36660238 PMCID: PMC9844667 DOI: 10.7759/cureus.33885] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
In hyperhidrosis, the body's sweat glands overact. Excessive sweating results from this overactivity, and for many hyperhidrosis patients, managing symptoms can be difficult in day-to-day life. Both surgical and non-surgical types of treatment are available for hyperhidrosis. Surgical treatments include microwave sympathectomy (video-assisted thoracic surgery and robotic). Da Vinci Si and Xi robotic systems are used. This review summarizes the outcomes, complications, advantages, and disadvantages of robotic sympathectomy. We conducted a literature search using PubMed, Cochrane, and Scopus. After analyzing nine articles, we found that robotic sympathectomy decreased compensatory hyperhidrosis with similar outcomes to other procedures. Robotic sympathectomy also reduced complications of Horner syndrome and has changed minimally invasive surgery significantly due to the reduction in tremors by a surgeon's hands to three-dimensional magnified views. It can potentially address the limitations of human video-assisted sympathectomy. However, the higher cost of robotic surgery, longer perioperative time due to the setting up of the machine, and higher training requirements are some of the disadvantages. The advantages of robotic sympathectomy are a reduction in compensatory sweating, better dexterity, loss of tremors, better visualization, and better accuracy. Although the overall success rates seem to be similar between robotic and video-assisted approaches, more studies are needed.
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Affiliation(s)
| | - Betsy Babu
- Medical School, Medical University of Sofia, Sofia, BGR
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Kermenli T, Gündoğdu Z, Cihangiroğlu Y. Long-term Effect of Endothoracic Sympathectomy with Clipping Method on Quality of Life in Primary Hyperhidrosis and Facial Flushing. Indian J Surg 2022. [DOI: 10.1007/s12262-021-02896-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Wolosker N, de Campos JRM, Kauffman P, da Silva MFA, Faustino CB, Tedde ML, Puech-Leão P, Fernandes PMP. Cohort study on 20 years' experience of bilateral video-assisted thoracic sympathectomy (VATS) for treatment of hyperhidrosis in 2431 patients. SAO PAULO MED J 2022; 140:284-289. [PMID: 35195234 PMCID: PMC9610237 DOI: 10.1590/1516-3180.2021.0078.r1.23072021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Primary hyperhidrosis is a condition characterized by excessive sweating, inconsistent with the needs for thermoregulation. OBJECTIVE To assess the effectiveness and the change in the quality of life of patients undergoing bilateral VATS (video-assisted thoracoscopic sympathectomy) for treatment of hyperhidrosis, in a large case series. DESIGN AND SETTING Cohort study conducted in a tertiary hospital specializing in hyperhidrosis located in São Paulo, Brazil. METHODS A total of 2,431 patients who underwent surgery consisting of bilateral video-assisted thoracoscopic sympathectomy between January 2000 and February 2017 were retrospectively assessed in an outpatient clinic specializing in hyperhidrosis. The patients underwent clinical and quality of life assessments on two occasions: firstly, prior to surgery, and subsequently, one month after the operation. The presence or absence of compensatory hyperhidrosis (CH) and general satisfaction after the first postoperative month were also evaluated. RESULTS All the patients operated had poor or very poor quality of life before surgery. In the postoperative period, an improvement in the quality of life was observed in more than 90% of the patients. Only 10.7% of the patients did not present CH, and severe CH occurred in 22.1% of the patients in this sample. CONCLUSION Bilateral VATS is a therapeutic method that decreases the degree of sweating more than 90% of patients with palmar and axillary hyperhidrosis. It improves the quality of life for more than 90% of the patients, at the expense of development of CH in approximately 90% of the patients, but not intensely.
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Affiliation(s)
- Nelson Wolosker
- MD, PhD. Full Professor, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil; and Surgeon, Department of Surgery, Vascular and Endovascular Division, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - José Ribas Milanez de Campos
- MD, PhD. Surgeon, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil; and Surgeon, Department of Surgery, Thoracic Surgery Division, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Paulo Kauffman
- MD, PhD. Surgeon, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil; and Surgeon, Department of Surgery, Vascular and Endovascular Division, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Marcelo Fiorelli Alexandrino da Silva
- MD. Surgeon, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil; and Surgeon, Department of Surgery, Vascular and Endovascular Division, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Carolina Brito Faustino
- MD. Surgeon, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil; and Surgeon, Department of Surgery, Vascular and Endovascular Division, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Miguel Lia Tedde
- MD, PhD. Surgeon, Department of Surgery, Thoracic Surgery Division, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Pedro Puech-Leão
- MD, PhD. Surgeon, Department of Surgery, Vascular and Endovascular Division, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Paulo Manuel Pêgo Fernandes
- MD, PhD. Full Professor, Thoracic Surgery Program, Instituto do Coração (InCor), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo (SP), Brazil; and Cardiothoracic Surgeon, Hospital Beneficência Portuguesa (BP), São Paulo (SP), Brazil.
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Bilateral Thoracoscopic Sympathectomy after Sternotomy for Left Ventricular Assist Device Insertion. Ann Thorac Surg 2022; 114:e319-e320. [PMID: 35085520 DOI: 10.1016/j.athoracsur.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/21/2021] [Accepted: 01/09/2022] [Indexed: 11/24/2022]
Abstract
Our case is a 73-year-old male with persistent ventricular tachycardia (VT) leading to recent syncopal episodes despite VT ablation and multiple stellate ganglion blocks, frequent hospital admissions, and acute on chronic congestive heart failure requiring intra-aortic balloon pump. The decision was made to proceed with left ventricular assist device placement and bilateral sympathectomies simultaneously. After performing the sternotomy and widely opening bilateral pleural spaces, the lower third of the stellate ganglia to the level of T4 was removed using a combination of the thoracoscope with the sternotomy incision. The use of thoracoscopy greatly assisted with visualization during the sympathectomy.
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Vanlommel J, Van Look L, Peetermans M, Uyttebroek L, van Nassauw L, Van Schil P. Anatomical variations of the upper thoracic sympathetic chain: a review. Eur J Cardiothorac Surg 2021; 61:515-522. [PMID: 34676399 DOI: 10.1093/ejcts/ezab445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The objective of this study is to provide a thorough overview of the anatomical variations of the upper thoracic sympathetic trunk to improve clinical results of upper thoracic sympathectomy. In addition, this study strives for standardization of future studies regarding the anatomy of the upper thoracic sympathetic chain. METHODS The Web of Science, PubMed and Google Scholar databases were searched using keywords, alone or combined, regarding the anatomy of the thoracic sympathetic chain. The search was limited to studies performed in humans. RESULTS Fifteen studies were finally included. Cervicothoracic ganglion and nerve of Kuntz were present in 77% and 53%, respectively. The upper thoracic ganglia were predominantly located in their corresponding intercostal space with a relatively downwards shift at the lower thoracic levels. The right sympathetic trunk is prone to have more communicating rami then the left. The lower levels of ganglia tend to have more normal rami. No clear pattern was found concerning the presence of the ascending rami and there was a decrease in the number of descending rami as the chain runs caudally. The intercostal rami remain a rare anatomical variation. CONCLUSIONS This study presents an overview of the anatomy of the upper thoracic sympathetic chain. Its results may guide upper thoracic sympathectomy to improve clinical results. This review also provides a baseline for future studies on anatomical variations of the thoracic sympathetic trunk. More uniform reporting is necessary to compare different anatomical studies.
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Affiliation(s)
- Jens Vanlommel
- Department ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Lawrence Van Look
- Department ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Maxime Peetermans
- Department ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Leen Uyttebroek
- Department ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Luc van Nassauw
- Department ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Paul Van Schil
- Department ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
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Puri HV, Asaf BB, Bishnoi S, Pulle MV, Sharma S, Kumar A. Thoracoscopic bilateral dorsal sympathectomy for primary palmo-axillary hyperhidrosis short- and mid-term results. J Minim Access Surg 2021; 17:532-536. [PMID: 33885020 PMCID: PMC8486074 DOI: 10.4103/jmas.jmas_174_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/21/2020] [Accepted: 01/03/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Thoracoscopic bilateral dorsal sympathectomy is the standard of care for primary palmo-axillary hyperhidrosis. This study aims at studying the surgical outcomes with special emphasis on the incidence of compensatory hyperhidrosis (CH) after thoracoscopic dorsal sympathectomy. Post-procedural patient satisfaction as well as quality of life was measured and analysed. MATERIALS AND METHODS This is a retrospective analysis of sixty thoracoscopic dorsal sympathectomy surgeries in thirty patients in a tertiary level thoracic surgery centre over 2 years. Various peri-operative variables were recorded and assessed. Incidence of CH was noted and analysed in relation to patient satisfaction and record was made of quality of life at the time of discharge, at 3 months and 1-year follow-up following surgery. RESULTS We performed sixty video-assisted thoracoscopic sympathectomies in 30 patients. The mean operative time was 44.93 ± 10 min. The mean hospital stay was 1 day. There were no immediate post-procedural complications. All the patients had complete resolution of palmar and axillary hyperhidrosis. Fifty per cent of our patients (15/30) had some degree of CH after surgery. Quality-of-life measurement showed very good satisfaction by 100% at discharge, by 93.3% at 3 months and at 1 year. Those 6.66% of patients were partially satisfied/not satisfied because of the presence of moderate-to-severe CH. CONCLUSION A significant percentage of the patients with primary palmo-axillary hyperhidrosis will be very satisfied with the procedure at 1 year after surgery despite 50% of them developing CH. Detailed counselling regarding CH in the pre-operative period would minimise the dissatisfaction rate after surgery.
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Affiliation(s)
| | - Belal Bin Asaf
- Centre For Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Sukhram Bishnoi
- Centre For Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Shikha Sharma
- Department of Anesthesia, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Arvind Kumar
- Centre For Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Rib-oriented Thoracoscopic Sympathetic Surgery for Hyperhidrosis: Prospective Long-term Results and Quality of Life. Surg Laparosc Endosc Percutan Tech 2021; 31:307-312. [PMID: 33605681 DOI: 10.1097/sle.0000000000000925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 12/03/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The optimal thoracoscopic sympathetic surgery for primary palmar and/or axillary hyperhidrosis (PPAH) is still unclear because of lack of uniform technique and qualitative/quantitative scales for definition of results. The aims of this study were to compare long-term outcomes based on the surgical technique and the level of sympathetic trunk interruption by clipping and to assess postoperative compensatory sweating (CS), patients' satisfaction, and quality of life (QoL). MATERIALS AND METHODS Between September 2009 and April 2016, 94 patients who underwent 2-stage bilateral thoracoscopic rib-oriented (R) sympathetic clipping were prospectively followed up through the administration of standardized preoperative and postoperative questionnaires.Thirty-four (36.2%) patients underwent single-port transaxillary access instead of the standard two 5-mm incisions. The level of sympathetic clipping for PPAH was R3+4(top and bottom); in patients who complained associated facial or plantar hyperhidrosis R2-bottom and R5-top were clipped, respectively. Seventy-five patients completed bilateral surgery. RESULTS There were no significant differences between single-port and biportal video-assisted thoracoscopic surgery in terms of operative times and postoperative results. At a mean follow-up of 72 (SD: 26) months, CS was reported in 42 (56%) patients, severe only in 6 (8%). It was higher in the case of R2-bottom clipping (P=0.03). Thirty-one of 60 (51.6%) patients who had a plantar hyperhidrosis declared an improvement of feet sweating after surgery. Postoperative satisfaction was excellent (86.11% on a 0 to 100 scale) and 95.4% of patients declared an improvement in QoL, which was statistically significant in all evaluated parameters. These results were not related to the level of clipping. CONCLUSION Thoracoscopic R3 to R4 clipping appears to be a safe and effective treatment for PPAH. Although postoperative CS was common and higher after R2-bottom clipping, this did not seem to affect patients' satisfaction and improvement in QoL.
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Abusailik MA, Mustafa SMB, Alzboun HM, Al-issa HA, Oweis SW, Alshudeifat AY, Nawaiseh MB. Primary Hyperhidrosis: Prevalence, Severity, and Impact on Quality of Life among Jordanian Patients. Indian J Dermatol 2021; 66:573. [PMID: 35068527 PMCID: PMC8751713 DOI: 10.4103/ijd.ijd_812_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Primary hyperhidrosis (PHH) is characterized by idiopathic, focal, bilateral, and symmetrical excessive and exaggerated sweating with a major impact on the quality of life (QoL). To date, there are no studies about the prevalence of PHH in Jordan and in the Arab region. AIM To assess the prevalence, severity, and characteristics of PHH in the Jordanian population as well as its impact on QoL. MATERIAL AND METHODS This study was conducted in five hospitals in Jordan and included 4,500 attendants of outpatient clinics who were evaluated for the presence of PHH. To assess the severity of hyperhidrosis (HH), we used the Hyperhidrosis Disease Severity Scale (HDSS). To evaluate the impact of HH on QoL, the Dermatology Life Quality Index (DLQI) questionnaire was answered by our patients, either digitally or on paper. RESULTS The overall prevalence of PHH in the Jordanian population was 3.2% (n = 144). The most common site was the axillae (63%), either isolated or in association with other sites. Both sexes were affected equally. The overall mean age of onset was 14.7 years. Positive family history was found in 35% of the patients. Nearly two-thirds of the patients presented with HDSS of 3 or 4. The impact on QoL was substantial with a mean DLQI of 12.8. CONCLUSION PHH prevalence in the Jordanian population is 3.2%, which has a major impact on QoL. This raises the need for addressing this disease to reduce its burden on patient lives.
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Affiliation(s)
| | - Safa M. Bani Mustafa
- From the Department of Dermatology, Jordanian Royal Medical Services, Amman, Jordan
| | - Habes M. Alzboun
- From the Department of Dermatology, Jordanian Royal Medical Services, Amman, Jordan
| | - Hussam A. Al-issa
- From the Department of Dermatology, Jordanian Royal Medical Services, Amman, Jordan
| | - Sami W. Oweis
- From the Department of Dermatology, Jordanian Royal Medical Services, Amman, Jordan
| | - Anas Y. Alshudeifat
- From the Department of Dermatology, Jordanian Royal Medical Services, Amman, Jordan
| | - Mohammed B. Nawaiseh
- Internship, Jordanian Royal Medical Services, Amman, Jordan,Address for correspondence: Dr. Mohammed B. Nawaiseh, Jordanian Royal Medical Services, Jubaiha - 11941, Amman, Jordan. E-mail:
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Çınar HU, Çelik B. Does the Sweating Severity of Primary Hyperhidrosis Sites Affect Post-Sympathotomy Results? Thorac Cardiovasc Surg 2020; 70:159-166. [PMID: 33368108 DOI: 10.1055/s-0040-1716389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Improvement in quality of life (QOL) and patient satisfaction after endoscopic thoracic sympathotomy (ETS) in patients with primary hyperhidrosis may be affected by various factors. We examined whether the preoperative sweating severity of primary hyperhidrosis sites affects postoperative results. METHODS The records of 112 patients who underwent bilateral ETS were reviewed retrospectively. The patients were divided into three groups according to the sweating severity score obtained from all primary hyperhidrosis sites (primary hyperhidrosis severity score [PHSS]) and analyzed comparatively. Group A (PHSS = 1-4) included 22 patients, Group B (PHSS = 5-8) 36 patients, and Group C (PHSS ≥ 9) 54 patients. Outcome measures included QOL prior to surgery, improvement in QOL after surgery, degree of clinical improvement, presence, severity, localization, and site number of reflex sweating (RS) and general patient satisfaction after 6 months of surgery. RESULTS The preoperative QOL of patients with higher PHSS (groups B, C) was worse than other patients (group A). More than 91% of all patients had any level improvement in QOL, and over 96% had slight or great clinical improvement. RS developed in 80% of the patients, mostly in the back, very severe in 8%, and in median two different body areas. The overall patient satisfaction rate was more than 95%. There was no significant difference between the three groups in terms of all postoperative results. CONCLUSION Preoperative sweating severity of primary hyperhidrosis sites does not affect post-sympathotomy results. Surgeons should not be worried when deciding upon surgery, even in patients with high sweating severity.
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Affiliation(s)
- Hüseyín Ulaş Çınar
- Department of Thoracic Surgery, Medicana International Samsun Hospital, Samsun, Turkey
| | - Burçin Çelik
- Department of Thoracic Surgery, Ondokuz Mayis University Medical School, Samsun, Turkey
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16
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Vasconcelos-Castro S, Soares-Oliveira M, Tuna T, Borges-Dias M. Thoracoscopic sympathotomy for palmar hyperhidrosis: How young is too young? J Pediatr Surg 2020; 55:2362-2365. [PMID: 31870560 DOI: 10.1016/j.jpedsurg.2019.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/15/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND/PURPOSE Primary hyperhidrosis affects 1%-3% of the general population, with increased incidence in teenagers, having an important impact in the quality of life. This study evaluates the efficacy and patients' satisfaction after bilateral thoracoscopic sympathotomy. METHODS Retrospective analysis of pediatric patients with palmar primary hyperhidrosis that underwent bilateral thoracoscopic sympathotomy over the last eight years. The procedure was performed with 2 ports and simple transection of the sympathetic chain. Pre and postoperative sweating severity was evaluated by telephone interview, using the Hyperhidrosis Disease Severity Scale (HDSS). RESULTS 23 patients (19 girls; 15.5 [11-19] years-old) underwent bilateral thoracoscopic sympathotomy. All complained of palmar hyperhidrosis, which resolved in all cases. Compensatory sweating occurred in 47.8% of patients. 21 patients answered the telephone interview: all of them would recommend the surgery to others. Sweating severity improved in all patients, with a mean decrease of 1.95 values of the HDSS from preoperative to postoperative evaluation (p < 0.05). There was neither morbidity nor mortality. CONCLUSIONS Bilateral thoracoscopic sympathotomy is a safe and effective treatment for primary palmar hyperhidrosis. Being the first report on pediatric application of HDSS, we conclude that children are very satisfied with the final outcome. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Miguel Soares-Oliveira
- Department of Pediatric Surgery, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Tiago Tuna
- Department of Pediatric Surgery, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Mariana Borges-Dias
- Department of Pediatric Surgery, Centro Hospitalar Universitário São João, Porto, Portugal
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El-Hag-Aly MA, Soliman RF, Zaid NA, Eldesouky MS, Bakoush MM, Hagag MG. Uniportal video-assisted thoracoscopic drainless sympathectomy for palmar and palmo-plantar hyperhidrosis: an institutional experience. THE CARDIOTHORACIC SURGEON 2020. [DOI: 10.1186/s43057-020-00030-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Primary hyperhidrosis (PH) still impacts negatively the patient’s quality of life (QoL). Progressively, it leads to poorer QoL regardless of gender. The endoscopic thoracic sympathectomy has been used safely and effectively for control of palmar hyperhidrosis, but it is still questionable in palmo-plantar type. We assessed the benefits of uniportal drainless thoracoscopic sympathectomy (UDTS) for palmo-plantar hyperhidrosis patients compared to palmar ones.
This prospective study comprised 213 consecutive patients with PH. They underwent bilateral simultaneous UDTS. We used the Hyperhidrosis Disease Severity Scale (HDSS) scoring system for assessment of QoL pre- and postoperatively. Follow-up was continued for 1-year that was aiming to detect the QoL improvement, recurrence, and compensatory hyperhidrosis (CH).
Results
All patients experienced immediate complete resolution of hyperhidrosis postoperatively. Recurrence was encountered in one patient during the first 6 months. All patients had improved QoL postoperatively, but at the end of 1-year follow-up, 2.8% of patients were still suffering moderate to severe impaired QoL. Mean hospital stay was 31.79 ± 17.5 h. We found significant longer hospital stay in palmar group than palmo-plantar group. There was no significant difference between both groups in neither operative time, recurrence, nor CH.
Conclusions
UDTS offers better QoL for patients with PH even the palmo-plantar type. The palmo-plantar type benefits similarly to the palmar type in terms of comparable postoperative QoL and CH incidence.
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18
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Mostafa MS, Elsherbeny M, Abdelbarr A, Abdelhay S. Thoracoscopic excision versus radiofrequency ablation of the sympathetic chain as a treatment for palmar hyperhidrosis: comparative study. ANNALS OF PEDIATRIC SURGERY 2020. [DOI: 10.1186/s43159-020-00031-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Abstract
Background
Hyperhidrosis is an excess sweat secretion. Various modalities of treatment exist for hyperhidrosis. Although medical treatment is the first line of treatment, its long-term outcome is not satisfactory. In this study, we compared the results of thoracoscopic excision with that of radiofrequency ablation of the sympathetic chain as a treatment of palmar hyperhidrosis.
Results
During the period from January 2014 to December 2017, 42 patients with palmar hyperhidrosis after failure of medical treatment presented to Departments of Pediatric Surgery and Neurosurgery, Faculty of Medicine. They were 26 males and 16 females. Their ages ranged between 11 and 42 years (mean 21.78 years). Twenty patients underwent thoracoscopic excision of the sympathetic chain (in Pediatric Surgery Department), while 22 patients underwent radiofrequency ablation of the sympathetic chain (in Neurosurgery Department). For the thoracoscopic sympathectomy group, the mean operative time was 27.39 min, the mean length of hospital stay was 24.78 h, the mean sweating scale decreased from 3.28 preoperatively to 1.33 1 year postoperatively, and the main postoperative complication was compensatory hyperhidrosis (40%). For the radiofrequency ablation group, the mean operative time was 55 min, the mean length of hospital stay was 20.64 h, the mean sweating scale decreased from 3.29 preoperatively to 1.57 1 year postoperatively, and the main postoperative complication was recurrence of hyperhidrosis (27%).
Conclusion
Thoracoscopic excision is more effective than radiofrequency ablation of the sympathetic chain in improving palmar hyperhidrosis. However, it has a higher risk of developing compensatory hyperhidrosis.
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19
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Texakalidis P, Tora MS, Federici T, Javidfar JJ, Boulis NM. Thoracoscopic delivery of therapeutics in the swine sympathetic chain: Implications for future neuromodulation. J Clin Neurosci 2020; 77:199-202. [DOI: 10.1016/j.jocn.2020.04.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
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20
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Han JW, Kim JJ, Jeong SC, Kim YH, Kim IS. Sympathotomy for severe compensatory hyperhidrosis in the trunk due to traumatic cervical spinal cord injury. J Thorac Dis 2020; 12:1115-1117. [PMID: 32274180 PMCID: PMC7138997 DOI: 10.21037/jtd.2020.01.62] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Jung Wook Han
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Jun Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seong Cheol Jeong
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Sub Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Wolosker N, Faustino CB, de Campos JRM, Kauffman P, Yazbek G, Fernandes PP, Cucato G. Comparative analysis of the results of videothoracoscopic sympathectomy in the treatment of hyperhidrosis in adolescent patients. J Pediatr Surg 2020; 55:418-424. [PMID: 32063368 DOI: 10.1016/j.jpedsurg.2019.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 08/25/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Several factors that could influence the efficacy and satisfaction of patients after bilateral thoracic sympathectomy (VATS) in the treatment of hyperhidrosis (HH) have been studied, but no studies in the literature have specifically analyzed the effectiveness of treatment and variations in the quality of life of adolescents patients compared to those of adult patients (18-40 years). METHODS We retrospectively analyzed 2431 hyperhidrosis patients who underwent bilateral VATS and divided the patients into the following groups: adolescents (472 patients) and adult group (1760 patients). Variables included quality of life prior to surgery, improvement in quality of life after surgery, clinical improvement in sweating, presence of severe compensatory hyperhidrosis and general satisfaction at one month after surgery. RESULTS We observed that all surgical patients presented with poor or very poor quality of life before surgery, with similar proportions in both groups. In the postoperative period, we observed improvement in quality of life in more than 90% of the patients, with no significant difference noted between the two groups of patients. We observed that all patients undergoing surgery presented poor or very poor quality of life before surgery; however, the two groups were statistically different. The quality of life of the ADOLESCENT group before surgery was statistically worse than that of the ADULT group. More than 90% of the patients in this series had great clinical improvement in the main hyperhidrosis site, with no significant difference between the two groups. Severe compensatory hyperhidrosis occurred in 23.8% of the patients in this series, with no significant difference between the two groups. CONCLUSIONS Adolescent patients benefit just as much as adult patients from VATS performed to treat primary hyperhidrosis, presenting excellent, significant surgical results. TYPE OF STUDY Clinical research. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
- Nelson Wolosker
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein
| | | | - Jose Ribas Milanez de Campos
- Division of Thoracic Surgery, Hospital Israelita Albert Einstein; Department of Surgery, Thoracic Surgery Division, University of São Paulo School of Medicine
| | - Paulo Kauffman
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein
| | - Guilherme Yazbek
- Department of Vascular and Endovascular Surgery, A.C. Camargo Cancer Center, Fundação Antônio Prudente
| | - Paulo Pêgo Fernandes
- Department of Surgery, Thoracic Surgery Division, University of São Paulo School of Medicine
| | - Gabriel Cucato
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein
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22
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Yeung C, Dawson J, Gilbert S. Uniportal video-assisted thoracoscopy approach to the management of non-pulmonary diseases of the chest. J Thorac Dis 2019; 11:S2062-S2068. [PMID: 31637039 DOI: 10.21037/jtd.2019.03.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The use of uniportal video-assisted thoracoscopy (u-VATS) is becoming a commonly used surgical technique and can be an effective approach for the surgical treatment of many pulmonary and non-pulmonary conditions. This review article summarizes current medical evidence informing the practice of u-VATS for treating non-pulmonary conditions including hyperhidrosis, hemothorax, pleural effusion, and thymic disease.
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Affiliation(s)
- Ching Yeung
- The Ottawa Hospital Research Institute, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada.,Faculty of Medicine, Department of Surgery, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada
| | - Jennifer Dawson
- The Ottawa Hospital Research Institute, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada
| | - Sebastien Gilbert
- The Ottawa Hospital Research Institute, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada.,Faculty of Medicine, Department of Surgery, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada
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Noguera MA, Romero CA, Martinez AG, Rotger ML, Roman HDS, Espeche FA. Free-standing ambulatory endoscopic transthoracic sympathectomy made with a urological resectoscope. J Minim Access Surg 2018; 16:289-291. [PMID: 30178765 PMCID: PMC7440017 DOI: 10.4103/jmas.jmas_135_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The endoscopic transthoracic sympathectomy (ETS) is an efficient procedure designed to treat palmar/axillary hyperhidrosis, now, we can present an original form to do this surgery with a single incision and using an urological resectoscope, always in a free-standing ambulatory public system in the province of Tucumán, in Argentina.
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Affiliation(s)
- Miguel Angel Noguera
- Department of Ambulatory Surgery, General Surgery Unit, President Nestor Kirchner Hospital, San Miguel de Tucuman, Argentina
| | - Cesar Alejandro Romero
- Department of Ambulatory Surgery, General Surgery Unit, President Nestor Kirchner Hospital, San Miguel de Tucuman, Argentina
| | - Aldo Gustavo Martinez
- Department of Ambulatory Surgery, General Surgery Unit, President Nestor Kirchner Hospital, San Miguel de Tucuman, Argentina
| | - Mariano Luis Rotger
- Department of Ambulatory Surgery, General Surgery Unit, President Nestor Kirchner Hospital, San Miguel de Tucuman, Argentina
| | - Hugo Diaz San Roman
- Department of Ambulatory Surgery, General Surgery Unit, President Nestor Kirchner Hospital, San Miguel de Tucuman, Argentina
| | - Federico A Espeche
- Department of Ambulatory Surgery, General Surgery Unit, President Nestor Kirchner Hospital, San Miguel de Tucuman, Argentina
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Lima SO, Santos RS, Varjao LL. Reply. J Vasc Surg 2018; 68:316. [PMID: 29937039 DOI: 10.1016/j.jvs.2018.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/02/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Sonia Oliveira Lima
- Programa de Mestrado e Doutorado Saúde e Ambiente, Universidade Tiradentes, Aracaju, Brazil
| | - Rafael Silva Santos
- Institute for Technology and Research, Laboratory of Nanotechnology and Nanomedicine, Aracaju, Brazil
| | - Lucas Leal Varjao
- Department of Medicine, Universidade Federal de Sergipe, Aracaju, Brazil
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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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Impact of Thoracoscopic T2 Sympathectomy on Patients With Primary Palmar and Axillary Hyperhidrosis. Ann Thorac Surg 2018; 106:1032-1037. [PMID: 29885980 DOI: 10.1016/j.athoracsur.2018.05.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 03/30/2018] [Accepted: 05/14/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND There are different techniques for thoracoscopic sympathectomy for management of primary hyperhidrosis. Each technique has the advantage of giving good surgical results, but may cause complications, which depend on the level of sympathectomy used in each technique. METHODS From October 2012 to August 2016, a total number of 120 patients (of primary palmar and axillary hyperhidrosis) were enrolled in this prospective randomized study. Patients were randomized preoperatively and divided into 2 groups: group A (underwent T2, T3, and T4 sympathectomy) and group B (underwent T3 and T4 sympathectomy) with 1 year of follow-up. Improvement of palm sweating, development of complications, patient satisfaction, and quality of life were evaluated. RESULTS Family history was positive in 33 patients (55%) in group A and in 31 patients (52%) in group B. All patients had improvement of hand sweating. Overdry hands were significant in group A (p = 0.032). Compensatory sweating was significant in group A after the first month (p = 0.016), after 6 months (p = 0.022), and after 12 months (p = 0.025). In group B, very satisfied patients were significant after 6 and 12 months (p = 0.002 and 0.000, respectively). CONCLUSIONS Limited sympathectomy to the level of T3 and T4 has the same therapeutic effect obtained by T2, T3, and T4 sympathectomy with less complications, greater patient satisfaction, and better quality of life. It should be the technique of choice for treatment of primary palmar and axillary hyperhidrosis.
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Associated with Ischemic Stroke Risk Reduction after Endoscopic Thoracic Sympathectomy for Palmar Sweating. J Stroke Cerebrovasc Dis 2018; 27:2235-2242. [PMID: 29784606 DOI: 10.1016/j.jstrokecerebrovasdis.2018.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/18/2018] [Accepted: 04/07/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Endoscopic thoracic sympathectomy (ETS) was performed to cure palmar hyperhidrosis (PH). After ETS, blood pressure decreased, and cerebral flow velocity increased within 1 month. However, no studies distinguish between subsequent ischemic and hemorrhagic stroke following ETS for PH. The association between stroke type and PH after ETS must be evaluated. METHODS We surveyed newly diagnosed patients with PH using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic code 780.8 from the Taiwan Longitudinal National Health Insurance Database. We matched patients with PH who underwent ETS (procedure code 05.29) and without surgery in the database between 2000 and 2010. We defined events as ischemic stroke (ICD-9-CM codes from 433 to 437) or hemorrhagic stroke (ICD-9-CM codes from 430 to 432). Patients were followed up until the first event or December 31, 2010. Risk factors for ischemic stroke and hemorrhagic stroke were analyzed using multivariable Cox proportional hazard regression. RESULTS The incidence of ischemic stroke was significantly lower in patients who underwent ETS (.22%) than in patients without surgery (.65%). The patients with PH who received ETS exhibited a reduced risk of ischemic stroke (adjusted hazard ratio [HR] .3; 95% confidence interval [CI] .12-.77). ETS treatment was not associated with a reduction in hemorrhagic stroke (adjusted HR .81; 95% CI .22-3; P = .755). CONCLUSIONS ETS in patients with PH was associated with reduced subsequent ischemic stroke risk. This additional ischemic stroke preventive effect should encourage health-care supporters to perform ETS in patients with severe PH.
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