Category: Sympathectomy

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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]