Category: Sympathectomy

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Comparing Compensatory Sweating After Video-Assisted Thoracoscopic Sympathectomy: (T2-3) Versus (T2-4) Levels for Treating Palmar Hyperhidrosis

Cureus. 2024 Nov 20;16(11):e74077. doi: 10.7759/cureus.74077. eCollection 2024 Nov.

ABSTRACT

INTRODUCTION: Primary hyperhidrosis is a disease that is characterized by excessive sweating beyond what is required to maintain the normal temperature of the body. Moreover, it has a great adverse effect on the life of the affected persons because of problems in their social lives. There are different modalities to treat primary hyperhidrosis, including medical and surgical treatment. However, in sympathectomy, there is still a lack of strong evidence regarding which level should be targeted to achieve maximum benefit with fewer complications.

METHODS: This prospective clinical study was conducted at the Cardiothoracic Surgery Department, Alexandria Main University Hospital, Alexandria, Egypt, from September 2021 to Jan 2022. The study involved a total of 50 eligible consecutive patients who had bilateral primary palmar hyperhidrosis managed by bilateral, bi-portal, and tubeless thoracoscopic approach with conventional general anesthesia. Group A represents 25 patients with 13 males (52%) who had sympathetic chain cutting at the level of T2-3, and group B represents 25 patients with 15 males (60%) who had sympathetic chain cutting at the level of T2-4. The effect on palmar hyperhidrosis, compensatory hyperhidrosis, and overall patient satisfaction was assessed on the Visual Analog Scale (VAS).

RESULT: Ninety-eight percent of patients in both groups showed postoperative complete dryness of the hand and improvement of their symptoms. There was a statistically significant (p<0.001) difference regarding the degree of severity of compensatory sweating post-operatively between both groups. In group A, 44% of patients had compensatory sweating, while in group B, 96% of patients had symptoms of compensatory sweating with varying degrees from 1 to 5 on a VAS-Score of five degrees.

CONCLUSION: The level of cauterization has no significant effect on palmar hyperhidrosis dryness after cutting the sympathetic chain at level (T2-3) vs. (T2-4). However, the greater the number of levels that are cauterized, which are three levels rather than two, the more severe the compensatory sweating in this study.

PMID:39712769 | PMC:PMC11661883 | DOI:10.7759/cureus.74077

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The effects of sympathectomy ganglion levels on late complications in the treatment of hyperhidrosis

J Minim Access Surg. 2024 Nov 29. doi: 10.4103/jmas.jmas_75_24. Online ahead of print.

ABSTRACT

INTRODUCTION: Pathologically excessive sweating in areas such as the palmar, axillary and/or plantar together with sympathetic hyperactivity that occurs independently of systemic causes is called primary hyperhidrosis. Although primary idiopathic hyperhidrosis can be seen at any age, the disease is most commonly seen in adolescents and young adults. The frequency of male and female genders is usually equal. Some medical and minimally invasive methods can be used in the treatment of primary hyperhidrosis. However, the known curative gold standard treatment method for the disease is thoracoscopic thoracic sympathectomy operation.

PATIENTS AND METHODS: In this study, a total of 150 patients who applied to Trakya University Health Practice and Research Center, Department of Thoracic Surgery, between 15 October 2008 and 15 June 2021 and underwent thoracoscopic thoracic sympathectomy due to the diagnosis of hyperhidrosis were evaluated retrospectively. The patients were separated into two groups. Thoracoscopic thoracic sympathectomy was performed on the T2-T4 in the first group (Group I – n : 88) and on the T3-T5 sympathetic ganglions in the second group (Group II – n : 62).

RESULTS: The median age of patients included in the study was found to be 24 (20.75-28) years. Group I and Group II were similar in terms of gender characteristics, but Group II was older. Our success rate was found to be 92% ( n = 138). There was no mortality, major complication such as bleeding requiring open thoracotomy, chylothorax or Horner’s syndrome in any of the patients. Minor complications were seen in the early and late period of the operation at a low rate. Our overall compensatory hyperhidrosis rate was 52% ( n = 78). Compensatory hyperhidrosis was detected more in Group I, although this was not statistically significant. We determined the overall satisfaction rate of our patients as 87.3% ( n = 133). The satisfaction rates of the patients in Group I and Group II were found to be similar.

CONCLUSIONS: Thoracoscopic thoracic sympathectomy is a fast, safe and minimally invasive treatment method with a low complication rate. More than 90% success and a significant increase in psychosocial condition and professional quality of life can be achieved with this procedure. Future studies are needed to reveal the relationship between operated ganglion levels and the development of compensatory hyperhidrosis.

PMID:39611563 | DOI:10.4103/jmas.jmas_75_24

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Sexual effects and long-term outcomes of endoscopic lumbar sympathectomy for plantar hyperhidrosis in men: a cross-sectional study

J Vasc Bras. 2024 Sep 27;23:e20240014. doi: 10.1590/1677-5449.202400142. eCollection 2024.

ABSTRACT

BACKGROUND: Plantar hyperhidrosis (PHH) is a disease with high psychosocial impact, and endoscopic lumbar sympathectomy (ELS) has been shown to be the best choice for treatment, but with some concerns such as compensatory sweating (CS) and sexual effects (SE), particularly in men.

OBJECTIVES: The aim of this study is to evaluate the long-term effectiveness of ELS for controlling PHH in men, its side effects, and perceived sexual modifications.

METHODS: A cross-sectional study including only male patients operated for PHH with ELS between 2014-2022 at a private practice. During remote interviews, patients were asked about symptoms before and after ELS and about the postoperative effects on PHH. They were also objectively asked about any SE during the postoperative period. Validated quality of life for hyperhidrosis and erectile function questionnaires were also administered.

RESULTS: 10 male patients averaging 4.26±2.86 years post-ELS were interviewed. Eight of them (80%) achieved complete response (≥80% of sweat reduction) in the first month after surgery and this response was maintained up to the interview date. Two patients had partial response. In six patients, CS occurred, with 5 reporting it as non-troublesome. Six patients reported some type of SE, but none reported erectile dysfunction. Regarding the functional results, all patients rated ELS from good (10%) to very good (30%) or excellent (60%).

CONCLUSIONS: Endoscopic lumbar sympathectomy was effective for treatment of plantar hyperhidrosis in these patients, improving their quality of life and providing lasting PHH control, with some transient sexual dysfunctions that did not impair their sexual life.

PMID:39421693 | PMC:PMC11486464 | DOI:10.1590/1677-5449.202400142

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Long term outcomes and risk factors of compensatory hyperhidrosis after thoracoscopic sympathectomy in primary palmar hyperhidrosis patients: a retrospective single-center study

J Cardiothorac Surg. 2024 Oct 4;19(1):590. doi: 10.1186/s13019-024-03086-y.

ABSTRACT

OBJECTIVE: This study aims to evaluate the long-term outcomes of compensatory hyperhidrosis (CH) after thoracoscopic sympathectomy and explore the risk factors affecting postoperative CH in primary palmar hyperhidrosis(PPH) patients.

METHOD: A retrospective analysis was conducted on patients who underwent thoracoscopic sympathectomy in the thoracic surgery department of our hospital from January 2015 to May 2022. Long-term follow-up surveys was conducted to collect data on post-operative satisfaction, PPH recurrence, and CH occurrence. Postoperative CH outcomes were assessed using the HDSS and satisfaction scores scale. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for postoperative CH.

RESULT: A total of 152 patients was included in the final study, with 113 cases in the CH group and 39 cases in the nCH group. The incidence of postoperative CH was 74.3% (113/152), within which 33.6% (38/113) were severe CH. The median follow-up time was 3.1 years(2.5-5.5y) and the median interval of CH onset after surgery was 30 days (14-90d). Univariate analysis showed that body mass index(BMI), surgical time, and transected nerve level are correlated with CH, with statistically significant differences. Multivariate logistic regression analysis indicated a higher BMI (OR = 0.864, 95% CI 0.755-0.989, P < 0.05) is the independent risk factor for the occurrence of CH. There was no statistically significant difference in HDSS scores among CH patients at 1 month, 1 year, and 3 years after surgery.

CONCLUSION: A higher BMI is the independent risk factor for postoperative CH after thoracoscopic sympathectomy. The incidence and severity of postoperative CH kept stable during a long term follow up.

PMID:39367483 | PMC:PMC11451246 | DOI:10.1186/s13019-024-03086-y

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Incidence and Severity of Compensatory Hyperhidrosis Following Bilateral Sympathectomy

Ann Vasc Surg. 2024 Jul 11:S0890-5096(24)00390-X. doi: 10.1016/j.avsg.2024.05.013. Online ahead of print.

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 in various degrees.

OBJECTIVE: The aim of this study was to assess the occurrence and characteristics of compensatory hyperhidrosis 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 was 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 ± 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 compensatory hyperhidrosis, more prevalent in males (64.1%) compared to females (35.8%). This compensatory hyperhidrosis 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 one week after surgery in 71.7% of cases, with 71.7% reporting mild to moderate symptoms. Compensatory hyperhidrosis 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 compensatory hyperhidrosis, most patients experience milder symptoms and express satisfaction, noting that their expectations were met following the surgery.

PMID:39002894 | DOI:10.1016/j.avsg.2024.05.013

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Evaluation of the clinical efficacy of ultra-fast track anesthesia for endoscopic thoracic sympathectomy of palmar hyperhidrosis

J Cosmet Dermatol. 2024 Jun 19. doi: 10.1111/jocd.16425. Online ahead of print.

ABSTRACT

OBJECTIVE: In this study, we investigated the safety and practicability of ultra-fast track anesthesia (UFTA) for endoscopic thoracic sympathectomy (ETS).

METHODS: A total of 72 patients with palmar hyperhidrosis undergoing ETS were randomly divided into three groups: the UFTA group (group I), the group undergoing single-lumen tracheal intubation with local infiltration anesthesia technique (group II), and the group undergoing single-lumen tracheal intubation with routine anesthesia (group III). Mean arterial pressure (MAP) and heart rate (HR) were recorded for all three groups at the following six time points: Before anesthetics administration (T0), the time of intubating or inserting laryngeal mask airway (T1), the time of incising skin (T2), the time of disconnecting of the right sympathetic nerve (T3), the time of disconnecting of the left sympathetic nerve (T4), the time of withdrawing the tracheal tube or laryngeal mask airway (T5), and the time of transferring the patient to a post-anesthesia care unit (PACU) (T6). The three groups were compared from the following perspectives: surgery duration; anesthesia recovery duration, that is, the duration from discontinuation of anesthesia to extubating the tracheal tube; the dose of propofol and remifentanil per kilogram body mass per unit time interval (the time at the end of the procedure, which lasted from anesthesia induction to incision suturing); and the visual analog scale (VAS) in the resting state in the PACU.

RESULTS: Based on pairwise comparisons, the average HR and average MAP values of the three groups differed significantly from T2 to T6 (p < 0.05). As demonstrated by the correlation analysis between remifentanil and propofol with HR and MAP, the doses of the total amount of remifentanil and propofol were lower, and group I used less remifentanil and propofol than group II. No patient in group I experienced throat discomfort following surgery. Patients in groups II and III experienced a range of postoperative discomfort. The VAS scores of groups I and II were significantly lower than those of group III, with group I lower than group II.

CONCLUSION: When utilized in ETS, UFTA can provide effective anesthesia for minor traumas. It is safe, effective, and consistent with the enhanced recovery philosophy of fast-track surgery departments.

PMID:38895860 | DOI:10.1111/jocd.16425

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Single-center experience of thoracoscopic sympathectomy for palmar hyperhidrosis with long-term postoperative questionnaire survey

Gen Thorac Cardiovasc Surg. 2024 Apr 27. doi: 10.1007/s11748-024-02034-w. Online ahead of print.

ABSTRACT

OBJECTIVES: Thoracoscopic sympathectomy is an effective treatment for palmar hyperhidrosis. However, compensatory hyperhidrosis occurs frequently as a postoperative complication of the procedure. The goal of this study was to elucidate the clinical significance of thoracoscopic sympathectomy using our surgical procedure.

METHODS: Consecutive 151 patients who underwent thoracoscopic sympathectomy for palmar hyperhidrosis were studied. In addition, to investigate patients’ satisfaction and long-term quality of life, 111 patients were asked to complete a mailing questionnaire survey, and 84 responded (response rate of 75.7%).

RESULTS: All of the 151 patients reported a reduction in palmar sweating during the immediate postoperative period. None of the patients had pneumothorax, hemothorax, Horner’s syndrome, or worsening of bradycardia. Based on the questionnaire, the surgical success rate was 98.8%. None of the patients had a recurrence of palmar hyperhidrosis during the long-term postoperative period. However, compensatory hyperhidrosis was reported in 82 patients (97.6%). In total, 94.0% of patients had high levels of postoperative satisfaction.

CONCLUSIONS: Thoracoscopic sympathectomy is an effective surgical treatment for palmar hyperhidrosis. By contrast, the careful preoperative explanation of compensatory hyperhidrosis is considered to be very important.

PMID:38676901 | DOI:10.1007/s11748-024-02034-w

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Fifteen Years’ Experience of Thoracoscopic Sympathetic Chain Interruption for Palmar Hyperhidrosis in Children and Adolescents: Evaluation of Different Techniques

J Laparoendosc Adv Surg Tech A. 2024 Apr 5. doi: 10.1089/lap.2024.0026. Online ahead of print.

ABSTRACT

Background: Thoracoscopic sympathetic chain interruption is a definitive and effective therapy for severe primary palmar hyperhidrosis (PPH). Well-known methods include sympathectomy, sympathotomy, and clipping, but the occurrence of compensatory sweating offsets these methods. This study aims to report our experience with thoracoscopic sympathetic chain interruption in a large group of patients of age <18 years with PPH, focusing on surgical outcomes, complication rates, and patient satisfaction. Patients and Methods: This retrospective study included patients who underwent thoracoscopic sympathectomy, sympathotomy, or clipping for severe PPH between April 2008 and March 2023 at the Pediatric Surgery Department, Al-Azhar University Hospitals. Demographic and clinical data, operative steps, postoperative outcomes, complications, and patient satisfaction were reviewed from the patients’ medical records. Results: During the 15-year study period, 420 children with PPH underwent bilateral thoracoscopic sympathetic chain interruption by either sympathectomy, sympathotomy, or clipping, with a sex ratio of 60% being females. The mean ages were 12 ± 3.48, 13 ± 2.45, and 13 ± 2.45 years, respectively. Sympathectomy was performed in 190 patients (45.2%), sympathotomy in 170 patients (40.5%), and clipping in 60 patients (14.3%). All patients had completed follow-up, with mean periods of ∼43 ± 5 months, 45 ± 3 months, and 42 ± 6 months, respectively. Complete palmar dryness was achieved in 405 patients (overall 96.4%) (97.8% after sympathectomy, 97.05% after sympathotomy, and 90% after clipping), whereas 2.1%, 2.9%, and 10% of patients experienced symptom recurrence, respectively, denoting significant statistical differences. Overall, 94 patients (22.4%) experienced compensatory sweating. Eventually, 409 patients (97.4%) were satisfied with the outcome, whereas 11 patients (2.6%) reported dissatisfaction, yet no significant differences found. Conclusion: The presented three modalities of thoracoscopic sympathetic chain interruption for PPH in children and adolescents are safe and effective, with overall very high postoperative satisfaction, despite a relatively high rate of compensatory sweating in sympathectomy group. Other major complications in this age population were scanty.

PMID:38577902 | DOI:10.1089/lap.2024.0026

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Efficacy and safety of radiofrequency ablation versus surgical sympathectomy in palmar hyperhidrosis

Sci Rep. 2024 Apr 1;14(1):7620. doi: 10.1038/s41598-024-57834-0.

ABSTRACT

Radiofrequency ablation (RFA) comparative efficacy of treatments using video-assisted thoracoscopic sympathectomy (VATS) in the long term remains uncertain in patients with palmar hyperhidrosis (PHH). This study aimed to compare the efficacy and safety of RFA and VATS in patients with PHH. We recruited patients aged ≥ 14 years with diagnosed PHH from 14 centres in China. The treatment options of RFA or VATS were assigned to two cohort in patients with PHH. The primary outcome was the efficacy at 1-year. A total of 807 patients were enrolled. After propensity score matching, the rate of complete remission was lower in RFA group than VATS group (95% CI 0.21-0.57; p < 0.001). However, the rates of palmar dryness (95% CI 0.38-0.92; p = 0.020), postoperative pain (95% CI 0.13-0.33; p < 0.001), and surgery-related complications (95% CI 0.19-0.85; p = 0.020) were lower in RFA group than in VATS group, but skin temperature rise was more common in RFA group (95% CI 1.84-3.58; p < 0.001). RFA had a lower success rate than VATS for the complete remission of PHH. However, the symptom burden and cost are lower in patients undergoing RFA compared to those undergoing VATS.Trial Registration: ChiCTR2000039576, URL: http://www.chictr.org.cn/index.aspx .

PMID:38556580 | DOI:10.1038/s41598-024-57834-0