Category: Sympathectomy

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Endoscopic lumbar sympathectomy following thoracic sympathectomy in patients with palmoplantar hyperhidrosis.

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Endoscopic lumbar sympathectomy following thoracic sympathectomy in patients with palmoplantar hyperhidrosis.

World J Surg. 2011 Jan;35(1):49-53

Authors: Rieger R, Loureiro Mde P, Pedevilla S, de Oliveira RA

Abstract
BACKGROUND: Palmoplantar hyperhidrosis is a common disease that leads to significant psychosocial strain for the affected person. Although the treatment of palmar symptoms with endoscopic thoracic sympathectomy (ETS) is clinically established, there are few data on the efficacy of an endoscopic lumbar sympathectomy (ELS) for the elimination of plantar symptoms. Especially the occurrence of unwanted side effects associated with sequential ETS and ELS has not been examined sufficiently.
METHODS: The study includes 130 patients, 8 men and 122 women, with severe palmoplantar hyperhidrosis who were already previously treated with ETS. An average of 28 months after the ETS, bilateral ELS was performed on all patients due to persistent severe plantar hyperhidrosis. After ELS the perioperative morbidity, elimination rate of the plantar hyperhidrosis, the frequency of unwanted side effects, and satisfaction with the result were evaluated. Follow-up examinations were carried out on 96 patients (74%) with a mean follow-up of 37 months (3-90 months).
RESULTS: A total of 260 lumbar sympathectomies were successfully carried out endoscopically. Mortality was zero, intraoperative complications occurred in three (2.3%) patients and postoperative complications in six (4.6%). Plantar hyperhidrosis was eliminated in 93 patients (97%), 3 (3%) patients developed a one-sided recurrence. Seven patients (7%) developed minor compensatory sweating, and in 17 patients (18%) compensatory sweating that existed before the ELS was slightly increased. Transient postsympathectomy neuralgia was observed in 18 patients (19%), and none of the patients showed a sexual function disorder. Altogether, 77 patients (80%) were very satisfied with the postoperative result, and 16 (17%) were partially satisfied.
CONCLUSIONS: The sesequential performance of ELS after ETS appears to be a safe, effective therapy option for patients with severe palmoplantar hyperhidrosis. However, more experience with a larger number of patients and longer follow-up investigations are necessary to confirm the safety of four-limb sympathectomy.

PMID: 20862474 [PubMed – indexed for MEDLINE]

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Endoscopic lumbar sympathectomy for focal plantar hyperhidrosis using the clamping method.

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Endoscopic lumbar sympathectomy for focal plantar hyperhidrosis using the clamping method.

Surg Laparosc Endosc Percutan Tech. 2010 Aug;20(4):231-6

Authors: Reisfeld R

Abstract
Surgical treatment for focal plantar hyperhidrosis is not yet well studied. Bilateral endoscopic lumbar sympathectomy (ELS), using the clamping method, was performed in 63 patients with focal plantar hyperhidrosis. Clamps were placed at L3 (46.0%) or L4 (52.4%), with one case at L2. All patients had improvement in foot sweating, with 96.6% achieving total anhidrosis. Five early cases had to be converted to an open surgical method. Complications were rare. No sexual problems were reported by the male patients. Compensatory sweating, already present in those with prior thoracic sympathectomy (n=56), remained unchanged in 91.1% and no severe compensatory sweating occurred in those who had only ELS. Postoperative pain was minimal. ELS is a viable option in the treatment of plantar hyperhidrosis, whether after a thoracic sympathectomy or in primary cases of plantar hyperhidrosis. Use of the clamping method provides good results with minimal postoperative pain or other complications.

PMID: 20729691 [PubMed – indexed for MEDLINE]

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Autonomic function following endoscopic thoracic sympathotomy for hyperhidrosis.

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Autonomic function following endoscopic thoracic sympathotomy for hyperhidrosis.

Clin Auton Res. 2011 Feb;21(1):11-7

Authors: Schmidt JE, Wehrwein EA, Gronbach LA, Atkinson JL, Fealey RD, Charkoudian N, Eisenach JH

Abstract
PURPOSE: Primary palmar-plantar hyperhidrosis is the condition of excessive sweating of the hands and feet. For severe and medically refractory cases, endoscopic thoracic sympathotomy (ETS) is a bilateral ganglion-sparing disconnection between the stellate and T2 ganglion in an effort to minimize compensatory hyperhidrosis. The purpose of this study was to determine the effect of ETS on cardiac autonomic function.
METHODS: Participants in this study were 22 otherwise healthy hyperhidrosis patients with 17 returning 1-12 months after surgery. Heart rate (HR) and blood pressure were collected at rest and during sequential nitroprusside/phenylephrine infusion (modified Oxford). To determine change in cardiac autonomic function, heart rate variability indices of RMSSD, LF and HF (log, nu) power were calculated. Sequential baroreflex sensitivity was also calculated.
RESULTS: After surgery, resting HR on standardized ECG tended to be lower and reached significance during the modified Oxford baseline (p < 0.001). HRV changed significantly between assessments with an increase in HF (nu) and decrease in LF (nu) and LF (log) spectral ranges (p < 0.05), while the increase in RMSSD was marginally significant (p < 0.06). Compared with matched controls, HRV indices were significantly different before surgery, but similar after surgery. No change was detected in resting sequential baroreflex sensitivity, baroslope obtained by modified Oxford or QTc interval.
CONCLUSIONS: We conclude that ETS changes cardiac autonomic modulation of HR to levels similar to controls. Despite the minimally destructive nature of ETS, effects on HRV are consistent with previously reported post-sympathectomy blunting of exaggerated sympathetic control associated with hyperhidrosis. No significant changes in the baroreflex indices suggest that ETS did not significantly affect blood pressure regulation.

PMID: 20700640 [PubMed – indexed for MEDLINE]

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Biportal thoracoscopic sympathectomy for palmar hyperhidrosis in adolescents.

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Biportal thoracoscopic sympathectomy for palmar hyperhidrosis in adolescents.

J Neurosurg Pediatr. 2010 Aug;6(2):183-7

Authors: Wait SD, Killory BD, Lekovic GP, Dickman CA

Abstract
OBJECT: Palmar, axillary, and plantar hyperhidrosis is often socially, emotionally, and physically disabling for adolescents. The authors report surgical outcomes in all adolescents treated for palmar hyperhidrosis via bilateral thoracoscopic sympathectomy at the Barrow Neurological Institute by the senior author.
METHODS: A prospectively maintained database of all adolescent patients undergoing bilateral thoracoscopic sympathectomy between 1998 and 2006 (inclusive) was reviewed. Additional follow-up was obtained as needed in clinic or by phone or written questionnaire.
RESULTS: Fifty-four patients (40 females) undergoing bilateral procedures were identified. Their mean age was 15.4 years (range 10-17 years). Average follow-up was 42 weeks (range 0.2-143 weeks). Hyperhidrosis involved the palms alone in 10 patients; the palms and axilla in 6 patients; the palms and plantar surfaces in 17 patients; and the palms, axilla, and plantar surfaces in 21 patients. Palmar hyperhidrosis resolved completely in 98.1% of the patients. Resolution or improvement of symptoms was seen in 96.3% of patients with axillary and 71.1% of those with plantar hyperhidrosis. Hospital stay averaged 0.37 days with 68.5% of patients discharged the day of surgery. One patient experienced brief intraoperative asystole that resolved with medications and had no long-term sequelae. Otherwise, no serious intraoperative complications occurred. No patient required chest tube drainage. The percentage of patients who reported satisfaction and willingness to undergo the procedure again was 98.1%.
CONCLUSIONS: Biportal, bilateral thoracoscopic sympathectomy is an effective and low-morbidity treatment for severe palmar, axillary, and plantar hyperhidrosis.

PMID: 20672941 [PubMed – indexed for MEDLINE]

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Bilateral retroperitoneoscopic lumbar sympathectomy by unilateral access for plantar hyperhidrosis in women.

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Bilateral retroperitoneoscopic lumbar sympathectomy by unilateral access for plantar hyperhidrosis in women.

J Laparoendosc Adv Surg Tech A. 2010 Feb;20(1):1-6

Authors: Coelho M, Kondo W, Stunitz LC, Branco Filho AJ, Branco AW

Abstract
OBJECTIVES: Primary focal hyperhidrosis is a disorder of excessive, bilateral, and relatively symmetric sweating occurring in the axillae, palms, soles, or craniofacial region. Armpits are affected in 51% of patients, feet in 29%, palms in 25%, and the face in 20%. There is a wide range of nonsurgical and surgical treatments available for patients with focal hyperhidrosis. Surgical treatments for plantar hyperhidrosis include thoracic and/or lumbar sympathectomy. In this article, we report on a new technique of bilateral retroperitoneoscopic lumbar sympathectomy by unilateral access for plantar hyperidrosis.
MATERIALS AND METHODS: The sample consisted of female patients who presented with plantar hyperhidrosis at the time of surgery and received bilateral retroperitoneoscopic lumbar sympathectomy by a unilateral access technique at our hospital. All patients had already been submitted to a previous thoracic sympathectomy with no improvement of the plantar hyperhidrosis.
RESULTS: Five procedures were performed successfully from January through March 2009. Mean operative time and mean estimated blood loss were 59 minutes and 54 cc, respectively. We had no intraoperative complications, and patients were discharged home 12.8 hours after surgery. Immediate warming of the feet was observed at the end of all procedures. On follow-up consultations, all patients referred a complete resolution of the plantar hyperhidrosis and 1 case of compensative hyperhidrosis on the back.
CONCLUSIONS: Retroperitoneoscopic lumbar sympathectomy by unilateral access seems to be feasible when performed by a surgeon with experience on advanced laparoscopy. Larger series comparing unilateral to bilateral access are necessary to establish the real benefits and potential disadvantages of this new technique.

PMID: 19943777 [PubMed – indexed for MEDLINE]

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Chemical lumbar sympathectomy in plantar hyperhidrosis.

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Chemical lumbar sympathectomy in plantar hyperhidrosis.

Clin Auton Res. 2010 Apr;20(2):113-5

Authors: Yoshida WB, Cataneo DC, Bomfim GA, Hasimoto E, Cataneo AJ

Abstract
Plantar hyperhidrosis can cause great changes to an individual’s quality of life. We described a case successfully treated by the minimally invasive method of percutaneous injection of 7.0% phenolic solution into the lumbar sympathetic chains.

PMID: 20012143 [PubMed – indexed for MEDLINE]

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Endoscopic lumbar sympathectomy for plantar hyperhidrosis.

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Endoscopic lumbar sympathectomy for plantar hyperhidrosis.

Br J Surg. 2009 Dec;96(12):1422-8

Authors: Rieger R, Pedevilla S, Pöchlauer S

Abstract
BACKGROUND: The aim of this study was to evaluate the results of endoscopic lumbar sympathectomy for plantar hyperhidrosis.
METHODS: A total of 178 endoscopic resections of the lower sympathetic lumbar trunk were carried out in 90 patients (59 men, 31 women) with severe plantar hyperhidrosis. The clinical results, including morbidity and satisfaction rates, were evaluated. Follow-up examination was carried out for all patients after a mean follow-up of 24 (range 3-45) months.
RESULTS: All procedures were carried out endoscopically. There were no deaths and only three patients had a postoperative complication. All patients had evidence of postoperative sympathetic denervation of the feet. In 87 patients (97 per cent) hyperhidrosis was eliminated, but in three (3 per cent) it recurred. Compensatory sweating occurred in 40 patients (44 per cent), postsympathectomy neuralgia in 38 (42 per cent) and one man suffered temporary loss of ejaculation. A total of 86 patients (96 per cent) were very, or partly, satisfied with the result, and 83 (92 per cent) would have the procedure repeated if required.
CONCLUSION: Endoscopic lumbar sympathectomy was a safe and effective option for patients with severe plantar hyperhidrosis.

PMID: 19918855 [PubMed – indexed for MEDLINE]