Category: Sympathectomy

Related Articles

To avoid compensatory hyperhidrosis after sympathetic surgery for craniofacial hyperhidrosis.

J Thorac Dis. 2020 May;12(5):2529-2535

Authors: Moon DH, Kang DY, Lee HS, Lee JW, Lee YJ, Lee S

Abstract
Background: Endoscopic thoracic sympathectomy (ETS) has not been widely adopted for treating craniofacial hyperhidrosis (CFH) due to its known postoperative complication, compensatory hyperhidrosis (CH). In this study, we evaluated whether the autonomic nerve analysis data via pre-ETS heart rate variability (HRV) test can predict post-ETS CH in patients with CFH.
Methods: From October 2017 to March 2019, we consecutively included CFH patients who underwent ETS and received preoperative HRV. In this prospective observational study, we evaluated those who developed CH 3 months postoperatively. The CH grades were categorized into none, mild, moderate, and severe.
Results: A total of 53 patients were included; the mean age was 42.5±13.2 years, and there were 41 males (77.4%). Twenty-six (49.1%) patients had a post-ETS CH grade of greater than moderate (moderate and severe). We further classified the group into trivial and serious compensation, based on the CH grade for comparison. Among the various HRV values, low frequency/high frequency (LF/HF) value was the only one that achieved statistical significance (P=0.025). Moreover, among those in the trivial compensatory group, 23 (85.2%) patients had an LF/HF value between 0.66 and 2.60, and therefore, were included in the autonomic balanced group. On the other hand, among those in the serious compensatory group, 24 patients (92.3%) had an LF/HF value of less than 0.66 and greater than 2.60, and thus, in the autonomic dysfunction group.
Conclusions: According to the present study, HRV test, especially the HF/LF value, appears to be a useful test in predicting post-ETS serious CH.

PMID: 32642160 [PubMed]

Related Articles

Video-assisted thoracoscopic sympathectomy versus modified Wittmoser method in surgical management of primary hyperhidrosis.

J Cardiothorac Surg. 2020 Jun 10;15(1):133

Authors: Divisi D, Zaccagna G, Imbriglio G, Di Francescantonio W, De Vico A, Barone M, Crisci R

Abstract
PURPOSES: We compared two different surgical methods evaluating the effectiveness of procedures and the quality of life (QoL) of patients.
METHODS: From January 2010 to November 2017 we carried out 476 biportal video-assisted thoracoscopic surgery (VATS) approaches of sympathetic chain in 238 patients. One hundred and twenty-nine (54%) patients underwent conventional sympathectomy (CS) while 109 (46%) patients underwent sympathicotomy associated with the division of the rami communicantes (MWT). Quality of Life (QoL) was classified as follows: from 20 to 35 excellent; from 36 to 51 very good; from 52 to 68 good; from 69 to 84 poor; and > 84 very poor.
RESULTS: We noticed statistical significant reduction of complications comparing CS with MWT approaches (chest pain from 36.4 to 4.5%; paresthesias from 8.5 to 3.6%; bradycardia from 28.6 to 10%, respectively). The preoperative and postoperative QoL index evaluation revealed a statistically significant improvement after surgery (CS: 86 ± 2 versus 35 ± 1, p = 0.00001; MWT: 85 ± 1 versus 33 ± 2, p = 0.00001), with general satisfaction of the two techniques.
CONCLUSION: Modified Wittmoser method seems to be a valid alternative to conventional sympathectomy, minimizing the percentage rate of complications and showing significant effectiveness in the quality of life improvement.

PMID: 32522214 [PubMed – in process]

Robotic Staged Bilateral Selective Postganglionic Sympathectomy for Upper-Extremity Hyperhidrosis.

Surg Technol Int. 2020 Apr 06;36:

Authors: Gharagozloo F, Meyer M, Tempesta B

Abstract
PURPOSE: The prevalence of compensatory hyperhidrosis (CH) has been reported to be as high as 80% in patients following thoracic sympathectomy for upper-extremity hyperhidrosis. The CH rate is 7.2% with simultaneous bilateral robotic selective dorsal sympathectomy. We reviewed the results in patients who underwent staged bilateral robotic selective dorsal sympathectomy (SBRSS).
METHODS: A case series analysis of patients who underwent SBRSS was performed. A surgical robot was used to divide the postganglionic sympathetic fibers and communicating rami to intercostal nerves 2, 3, and 4. The sympathetic chain was left intact. The operation was performed on the dominant side, and the same procedure was then performed on the contralateral side after 4 weeks. The success of the sympathectomy was determined by intraoperative temperature measurement, patient interviews, and the Hyperhidrosis Disease Severity Scale.
RESULTS: There were 47 patients (22 men, 25 women), with a mean age of 22 ± 3 years. Minor complications were seen in 4% of patients. One patient had transient heart block. One patient had transient partial Horner’s syndrome. Forty percent of patients had transient CH after the first surgery, and 45% had transient CH after sympathectomy on the contralateral side. There were no deaths. The median hospitalization was 3 days. At a mean follow-up of 28 ± 6 months, 46/47 patients (98%) had sustained relief of hyperhidrosis. In one patient (1/47, 2%), hyperhidrosis recurred on the first operated side. One patient (2%) exhibited sustained CH.
CONCLUSION: SBRSS is associated with a lower rate of CH than when the procedure is performed bilaterally in a simultaneous fashion. This procedure is associated with the lowest reported rate of CH.

PMID: 32250442 [PubMed – as supplied by publisher]