Sympathectomy – Page 13 – Hyperhidrosis Research . org

November 11, 2018

Severe plantar hyperhidrosis: an effective surgical solution.

Severe plantar hyperhidrosis: an effective surgical solution.

Am Surg. 2013 Aug;79(8):845-53

Authors: Reisfeld R, Pasternack GA, Daniels PD, Basseri E, Nishi GK, Berliner KI

Abstract
Severe palmoplantar hyperhidrosis both affects activities of daily living and diminishes quality of life. This study evaluated overall safety and efficacy of endoscopic lumbar sympathectomy (ELS) using a clamping method in a large series of consecutive patients. Patient data were routinely entered into a prospectively designed database. Plantar sweating was graded as cured, improved, or unchanged. ELS (using 5-mm titanium clips) was performed in 154 patients, 68.2 per cent at the third lumbar vertebrae and 31.8 per cent at the fourth lumbar vertebrae. Follow-up averaged 15 months and ranged up to 4.7 years. Anhidrosis was achieved in 97.4 per cent of patients with the remainder reporting major reduction in symptoms. All patients were discharged home within 24 hours of surgery, requiring only oral analgesics, if any. There were two surgical complications (lymphatic leak and misidentification of genitofemoral nerve for sympathetic nerve). Six early patients required conversion to an open surgical procedure. Partial recurrence, usually mild, occurred in 4.5 per cent with 2.6 per cent requiring revision surgery. Severe plantar hyperhidrosis can be safely and effectively treated by endoscopic lumbar sympathectomy using the clamping method. It can be accomplished on an outpatient basis with low morbidity, complete resolution of symptoms, and a significant improvement in quality of life.

PMID: 23896256 [PubMed – indexed for MEDLINE]

November 11, 2018

Long-term results of thoracic sympathectomy for primary hyperhidrosis.

Long-term results of thoracic sympathectomy for primary hyperhidrosis.

Pol Przegl Chir. 2013 May;85(5):247-52

Authors: Stefaniak TJ, Ćwigoń M

Abstract
UNLABELLED: The side effects following thoracic sympathectomy for primary hyperhidrosis include pain and compensatory/ reflex sweating. The aim of the study was the evaluation of the results of the endoscopic sympathicotomy with clips with emphasis on the frequency of side effects following the operation.
MATERIAL AND METHODS: Two-hundred-eighty-three patients were qualified to thoracic T3-T4 sympathicotomy with clips. In all cases bilateral procedure in prone position with CO2 insufflation was performed. The subjective intensity of disease was evaluated by VAS scale (0–no sweating; 10–maximal possible sweating) while the recurrence of the sweating in primary localization, intensity and dynamics of compensatory and plantar sweating were evaluated post-operatively. Follow-up data were obtained during office visits 3, 12 and 36 months after surgery. The overall follow-up response was 74.6%.
RESULTS: There was no mortality. Perioperative morbidity included 6 cases of pneumothorax. The mean duration of surgery was 57 minutes bilaterally. The postoperative intercostal pain was present in all patients (100%) with mean duration of 21.88 days but in 72.6% of cases it did not demand any medication as early as 48 hours after surgery. Strong or very strong compensatory sweating was observed in 17.5% of cases 3 months after ETS, in 14.1% after 12 months and in 23.6% after 36 months.
CONCLUSIONS: Thoracic sympathicotomy with clips is a safe treatment that provides satisfactory longterm results. The incidence of side-effects (intercostal pain, compensatory sweating) is high and does not change with time in most of the cases.

PMID: 23770524 [PubMed – indexed for MEDLINE]

November 11, 2018

Objective evaluation of plantar hyperhidrosis after sympathectomy.

Icon for Scientific Electronic Library Online

Objective evaluation of plantar hyperhidrosis after sympathectomy.

Clinics (Sao Paulo). 2013;68(3):311-5

Authors: Wolosker N, Ishy A, Yazbek G, Campos JR, Kauffman P, Puech-Leão P, Jatene FB

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.

PMID: 23644849 [PubMed – indexed for MEDLINE]

November 11, 2018

Thoracoscopic sympathectomy for palmar hyperhidrosis in children: 21 years of experience at a tertiary care center.

Thoracoscopic sympathectomy for palmar hyperhidrosis in children: 21 years of experience at a tertiary care center.

Eur J Pediatr Surg. 2013 Dec;23(6):486-9

Authors: Sinha CK, Kiely E

Abstract
PURPOSE: The aim of this study was to find out the outcome of “thoracoscopic sympathectomy” (TS) for palmar hyperhidrosis (PH) in children. To our knowledge, this is the largest experience of TS from the United Kingdom.
METHOD: All patients who underwent TS for PH during the past 21 years were studied retrospectively.
RESULTS: A total of 85 procedures were done in 44 children. Ratio of female to male was 4:1. Median age at operation was 12.8 years. Types of operations performed were as follows: bilateral T2-T3 sympathectomy in 87% (38/44), bilateral T2-T5 sympathectomy in 9% (4/44), and right-sided thoracoscopic (left-sided done open) in 1% (0.5/44); operation was not possible in 3% (1.5/44) of cases. No chest drains were used. Median postoperative stay was 2 days (range 1 to 5). Median follow-up time was 1.3 years (range 0.2 to 4.7 years). Only problematic patients were followed up for longer. During follow-up, 21% (9/44) developed severe hyperhidrosis of other parts of body. Seven percent (3/44) of patients developed severe axillary hyperhidrosis (AH) and required T4-T5 sympathectomy later on at a median age of 14.4 years (range 11 to 16 years). Another 9% (4/44) patients developed severe plantar hyperhidrosis. Severe hyperhidrosis of the whole body was seen in 5% (2/44) of the patients. Postoperative complications were seen in 47% (21/44) of the patients. They were as follows: postoperative pain (needing > 48 hours hospital stay) in 18% (8/44); transient Horner syndrome in 18% (8/44-right 5, left 3); and recurrence of PH in 11% (5/44) of cases. In the recurrence group, 7% (3/44) were unilateral (right 2, left 1) and 5% (2/44) were bilateral. Redo operations were performed in 11% (5/44) of cases. Median time to redo was 2.6 years (range 8 months to 4.2 years). All three unilateral recurrent patients underwent respective sided redo. In the bilateral recurrence group (2/44), one patient had bilateral redo (remained dry), whereas the other patient underwent only right-sided operation (remained dry), as that sided operation was difficult and so the other side was not tried. FINAL OUTCOMES: The final outcomes were recurrence 3.5% (3/85-right 2, left 1) and technically failed operation 3.5% (3/85-both sides 1, one side 1). Success rate for thoracoscopic sympathetectomy was 93% (79/85) overall.
CONCLUSION: TS for PH is a safe and feasible operation in children. It is successful in the majority; however, the procedure is not trouble free.

PMID: 23460464 [PubMed – indexed for MEDLINE]

November 11, 2018

A randomized placebo-controlled trial of oxybutynin for the initial treatment of palmar and axillary hyperhidrosis.

A randomized placebo-controlled trial of oxybutynin for the initial treatment of palmar and axillary hyperhidrosis.

J Vasc Surg. 2012 Jun;55(6):1696-700

Authors: Wolosker N, de Campos JR, Kauffman P, Puech-Leão P

Abstract
INTRODUCTION: Video-assisted thoracic sympathectomy provides excellent resolution of palmar and axillary hyperhidrosis but is associated with compensatory hyperhidrosis. Low doses of oxybutynin, an anticholinergic medication that competitively antagonizes the muscarinic acetylcholine receptor, can be used to treat palmar hyperhidrosis with fewer side effects.
OBJECTIVE: This study evaluated the effectiveness and patient satisfaction of oral oxybutynin at low doses (5 mg twice daily) compared with placebo for treating palmar hyperhidrosis.
METHODS: This was prospective, randomized, and controlled study. From December 2010 to February 2011, 50 consecutive patients with palmar hyperhidrosis were treated with oxybutynin or placebo. Data were collected from 50 patients, but 5 (10.0%) were lost to follow-up. During the first week, patients received 2.5 mg of oxybutynin once daily in the evening. From days 8 to 21, they received 2.5 mg twice daily, and from day 22 to the end of week 6, they received 5 mg twice daily. All patients underwent two evaluations, before and after (6 weeks) the oxybutynin treatment, using a clinical questionnaire and a clinical protocol for quality of life.
RESULTS: Palmar and axillary hyperhidrosis improved in >70% of the patients, and 47.8% of those presented great improvement. Plantar hyperhidrosis improved in >90% of the patients. Most patients (65.2%) showed improvements in their quality of life. The side effects were minor, with dry mouth being the most frequent (47.8%).
CONCLUSIONS: Treatment of palmar and axillary hyperhidrosis with oxybutynin is a good initial alternative for treatment given that it presents good results and improves quality of life.

PMID: 22341836 [PubMed – indexed for MEDLINE]

November 11, 2018

Impact of T3 thoracoscopic sympathectomy on pupillary function: a cause of partial Horner’s syndrome?

Impact of T3 thoracoscopic sympathectomy on pupillary function: a cause of partial Horner’s syndrome?

Surg Endosc. 2012 Apr;26(4):1146-52

Authors: Ramos R, Ureña A, Rivas F, Macia I, Rosado G, Pequeño S, Masuet C, Badia M, Miguel M, Delgado MA, Escobar I, Moya J

Abstract
BACKGROUND: Thoracoscopic bilateral sympathicolysis of the T3 sympathetic ganglia is an effective treatment for palmar hyperhidrosis, though not without potential complications and consequences such as Horner’s syndrome. The objective of our study is to evaluate the repercussion of T3 sympathetic denervation on pupillary tone in patients with primary hyperhidrosis.
METHODS: A prospective descriptive study of 25 patients (50 pupils) ranging in age from 18 to 40 years with an indication of T3 sympathectomy for palmar hyperhidrosis or palmar-plantar hyperhidrosis from 1 December 2009 to 31 December 2010 was carried out. We excluded all patients with previous eye surgery or other ocular pathologies and those with pathologies that contraindicate denervation surgery and ocular study. All patients were evaluated before surgery and at 24 h and 1 month after sympathetic denervation. Pupil/iris (P/I) ratio was measured before and after instillation of sympathicomimetic eye drops containing 1% apraclonidine.
RESULTS: No statistically significant differences were found when we compared the preoperative P/I ratio of the left eyes versus the right eyes (P = 0.917). We found statistically significant differences (P < 0.001) between the preoperative P/I ratio [0.40 mm (standard deviation, SD 0.07 mm)] and the postoperative basal ratio [0.33 (SD 0.05)] at 24 h. The P/I ratio at 24 h increased from 0.33 to 0.36 (SD 0.09), a nonsignificant increase (P = 0.45), after instillation of medicated eye drops. No differences were observed between the preoperative [0.40 (SD 0.07)] and 1-month basal values [0.38 (SD 0.07)], and instillation of apraclonidine no longer induced a hypersensitivity response.
CONCLUSIONS: T3 sympathectomy leads to subclinical pupillary dysfunction with a tendency for miosis, even though this impairment is not generally evident on standard physical examination or reported by patients. This subclinical dysfunction may be caused by injury to an undefined group of presympathetic nerve cell axons in caudocranial direction that communicate with the cervical sympathetic ganglia and whose function is mydriatic pupillary innervation.

PMID: 22044979 [PubMed – indexed for MEDLINE]

November 11, 2018

Is T3 and T6 sympathetic clipping more effective in primary palmoplantar hyperhydrosis?

Is T3 and T6 sympathetic clipping more effective in primary palmoplantar hyperhydrosis?

Thorac Cardiovasc Surg. 2011 Sep;59(6):357-9

Authors: Gorur R, Yiyit N, Yildizhan A, Candas F, Turut H, Sen H, Isitmangil T

Abstract
OBJECTIVE: Our aim was to establish a standardized approach for patients with palmoplantar and axillary hyperhidrosis and to compare patient satisfaction and complication rates for two different operations.
MATERIALS AND METHODS: Between 2008 and 2010, 30 patients underwent conventional T3/4 clipping (group A), and 30 underwent only T3 and T6 clipping (group B). Both groups were compared with regard to compensatory sweating (CS), complications, patient satisfaction and recovery of plantar hyperhidrosis.
RESULTS: The CS rate was 60 % in group A and 47 % in group B. CS was significantly less in group B compared to group A ( P ≤ 0.001). The plantar hyperhidrosis recovery rate was higher in group B (n = 19) compared to group A (n = 13), but the difference was not statistically significant ( P ≥ 0.299). Patient satisfaction rate was 93.3 % in group A and 96.6 % in group B.
CONCLUSIONS: Our study showed that T3/6 clipping was as effective as T3/4 clipping for palmar and axillary hyperhidrosis. Our results revealed that this technique is more effective than T3/4 sympathectomy to treat plantar hyperhidrosis.

PMID: 21766277 [PubMed – indexed for MEDLINE]

November 11, 2018

Treatment options for hyperhidrosis.

Treatment options for hyperhidrosis.

Am J Clin Dermatol. 2011 Oct 01;12(5):285-95

Authors: Walling HW, Swick BL

Abstract
Hyperhidrosis is a disorder of excessive sweating beyond what is expected for thermoregulatory needs and environmental conditions. Primary hyperhidrosis has an estimated prevalence of nearly 3% and is associated with significant medical and psychosocial consequences. Most cases of hyperhidrosis involve areas of high eccrine density, particularly the axillae, palms, and soles, and less often the craniofacial area. Multiple therapies are available for the treatment of hyperhidrosis. Options include topical medications (most commonly aluminum chloride), iontophoresis, botulinum toxin injections, systemic medications (including glycopyrrolate and clonidine), and surgery (most commonly endoscopic thoracic sympathectomy [ETS]). The purpose of this article is to comprehensively review the literature on the subject, with a focus on new and emerging treatment options. Updated therapeutic algorithms are proposed for each commonly affected anatomic site, with practical procedural guidelines. For axillary and palmoplantar hyperhidrosis, topical treatment is recommended as first-line treatment. For axillary hyperhidrosis, botulinum toxin injections are recommended as second-line treatment, oral medications as third-line treatment, local surgery as fourth-line treatment, and ETS as fifth-line treatment. For palmar and plantar hyperhidrosis, we consider a trial of oral medications (glycopyrrolate 1-2 mg once or twice daily preferred to clonidine 0.1 mg twice daily) as second-line therapy due to the low cost, convenience, and emerging literature supporting their excellent safety and reasonable efficacy. Iontophoresis is considered third-line therapy for palmoplantar hyperhidrosis; efficacy is high although so are the initial levels of cost and inconvenience. Botulinum toxin injections are considered fourth-line treatment for palmoplantar hyperhidrosis; efficacy is high though the treatment remains expensive, must be repeated every 3-6 months, and is associated with pain and/or anesthesia-related complications. ETS is a fifth-line option for palmar hyperhidrosis but is not recommended for plantar hyperhidrosis due to anatomic risks. For craniofacial hyperhidrosis, oral medications (either glycopyrrolate or clonidine) are considered first-line therapy. Topical medications or botulinum toxin injections may be useful in some cases and ETS is an option for severe craniofacial hyperhidrosis.

PMID: 21714579 [PubMed – indexed for MEDLINE]

November 11, 2018

Factors affecting long-term satisfaction after thoracic sympathectomy for palmar and plantar hyperhidrosis. Is the sudomotor reflex the only villain?

Icon for Silverchair Information Systems

Factors affecting long-term satisfaction after thoracic sympathectomy for palmar and plantar hyperhidrosis. Is the sudomotor reflex the only villain?

Interact Cardiovasc Thorac Surg. 2011 Apr;12(4):554-7

Authors: de Lima AG, Das-Neves-Pereira JC, de Campos JR, Jatene FB

Abstract
The main objective of this study was to determine if there are variations in the level of improvement of the palmar and plantar hyperhidrotic symptoms, as well as the incidence and intensity of the sudomotor reflex, throughout the seasons of the year, after thoracic sympathectomy for hyperhidrosis. The study also looks for the real impact of these variables in the long-term satisfaction. A cohort of 75 patients was followed through distinct seasons. A multivariate analysis was performed to identify possible variables responsible for dissatisfaction. Both the palmar (P=0.002) and plantar (P<0.001) symptoms and the presence and the intensity of the sudomotor reflex varies significantly throughout the seasons of the year. The sudomotor reflex was the main factor associated with low satisfaction in our patients in the summer (P=0.025) and winter (P<0.001) but in spring the lack of improvement in the hyperhidrosis in the foot was the unique factor related to dissatisfaction (P<0.001). The sudomotor reflex is the main negative factor in the summer and in the winter, independent of its intensity. However, at least in spring, the lack of removal of the plantar symptoms had a negative impact on satisfaction.

PMID: 21172946 [PubMed – indexed for MEDLINE]

November 11, 2018

Laparoendoscopic single-site retroperitoneal lumbar sympathectomy: initial report.

Laparoendoscopic single-site retroperitoneal lumbar sympathectomy: initial report.

Neurosurgery. 2011 Jun;68(2 Suppl Operative):291-3

Authors: Li TC, Chung SD, Tai PA, Hsu HT, Wen CS, Huang KF, Tsai YC

Abstract
BACKGROUND: Retroperitoneoscopic lumbar sympathectomy is a safe and effective treatment for plantar hyperhidrosis.
OBJECTIVE: To evaluate the safety and feasibility of laparoendoscopic single-site retroperitoneal lumbar sympathectomy in plantar hyperhidrosis.
METHODS: Bilateral laparoendoscopic single-site retroperitoneal lumbar sympathectomy was performed in a 27-year-old man who suffered from excessive sweating from the soles of the feet. A homemade single port was created with an Alexis wound retractor through a 2.5-cm incision at the tip of the 12th rib. With conventional 5-mm laparoscopy and instruments, retroperitoneal lumbar sympathectomy was performed.
RESULTS: The procedure was completed successfully without any complications and with minimal blood loss. The operative time was 110 and 80 minutes for the procedure on the left and right sides. The perioperative course and postoperative course were uneventful. The patient had anhidrosis of both feet after surgery with Hyperhidrosis Disease Severity Scale score of 1 at the 1-month follow-up.
CONCLUSION: Laparoendoscopic single-site retroperitoneal lumbar sympathectomy is a safe and feasible procedure according to our initial experience.

PMID: 21336211 [PubMed – indexed for MEDLINE]