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Nationwide Cross-Sectional Analysis of Endoscopic Thoracic Sympathectomy to Treat Hyperhidrosis over 12 years in Brazil: Epidemiology, Costs and Mortality

Ann Surg. 2021 Aug 19. doi: 10.1097/SLA.0000000000005178. Online ahead of print.

ABSTRACT

OBJECTIVE: to analyze the number of endoscopic thoracic sympathectomies performed to treat hyperhidrosis in the Universal Public Health System of Brazil, the government reimbursements and the in-hospital mortality rates.

BACKGROUND: Even though endoscopic thoracic sympathectomy has been widely performed for the definitive treatment of hyperhidrosis, no series reported mortality and there are no population-based studies evaluating its costs or its mortality rate.

MATERIALS AND METHODS: Data referring to endoscopic thoracic sympathectomy to treat hyperhidrosis between 2008 and 2019 were extracted from the database of the Brazilian Public Health System, which insures more than 160 millions inhabitants.

RESULTS: 13,201 endoscopic thoracic sympathectomies to treat hyperhidrosis were performed from 2008 to 2019, with a rate of 68.44 procedures per 10 million inhabitants per year. There were 6 in-hospital deaths during the whole period, representing a mortality rate of 0.045%. The total expended throughout the years was U$ 6,767,825.14, with and average of U$ 512.68 per patient.

CONCLUSIONS: We observed a rate of 68.44 thoracoscopic sympathectomies for hyperhidrosis’ treatment per 10 million inhabitants per year. The in-hospital mortality rate was very low, 0.045%, though not nil. To our knowledge, no published series is larger than ours and we are the first authors to formally report deaths following endoscopic thoracic sympathectomies to treat hyperhidrosis. Moreover, there is no other population-based study addressing costs and mortality rates of every endoscopic thoracic sympathectomy for the treatment of any site of hyperhidrosis in a given period.

PMID:34417365 | DOI:10.1097/SLA.0000000000005178

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Treatment of Axillary hyperhidrosis

J Cosmet Dermatol. 2021 Aug 20. doi: 10.1111/jocd.14378. Online ahead of print.

ABSTRACT

BACKGROUND: Axillary hyperhidrosis characterized by excessive sweating in the axillary regions is a frustrating chronic autonomic disorder leading to social embarrassment, impaired quality of life and usually associated with palmoplantar hyperhidrosis. Identifying the condition and its cause is central to the management.

AIM: The aim of this article is to discuss treatment options for axillary hyperhidrosis.

METHODS: Comprehensive literature search using PubMed and Google Scholar was performed to review relevant published articles related to diagnosis and treatment of axillary hyperhidrosis.

RESULTS: Treatment modalities for axillary hyperhydrosis vary from topical and systemic agents to injectables, newer devices and surgical measures. None except for physical measures using devices or surgery, which destroys the sweat glands to remove them, is possibly permanent and most are associated with attendant side effects.

CONCLUSION: Several treatments including medical and surgical option are available for the treatment of axillary hyperhydrosis. Patient education is important component of its management. Individualized approach of management is necessary for optimal outcome of treatment.

PMID:34416078 | DOI:10.1111/jocd.14378

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Evaluation of compensatory hyperhidrosis after sympathectomy: the use of an objective method

Ann Vasc Surg. 2021 Aug 16:S0890-5096(21)00479-9. doi: 10.1016/j.avsg.2021.05.014. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the prevalence of compensatory hyperhidrosis following videothoracic sympathectomy to treat palmoplantar hyperhidrosis and its effect on sweating in the chest, abdomen, back and thighs. Furthermore, to evaluate the concordance between a subjective and an objective method of assessment for compensatory hyperhidrosis.

METHODS: Forty patients with combined palmar and plantar hyperhidrosis who underwent video assisted thoracoscopic sympathectomy (15 women and 25 men, with a mean age of 25 years) were prospectively followed for one year. Subjective and objective parameters were evaluated, using respectively a questionnaire and a sudorometer (Vapometer).

RESULTS: In the subjective analysis, in the first month, only 10% of patients did not have compensatory hyperhidrosis, and 70% continued to report it at one or more sites after 1 year. In the objective analysis, 35% of the patients did not present compensatory hyperhidrosis after 1 month, and this number persisted stable, with 30% of patients remaining free of compensatory hyperhidrosis after 1 year. The most frequent area affected by compensatory hyperhidrosis was the back in both assessments. There was no positive concordance between the results of the objective and the subjective analysis at any time in any of the 4 regions studied.

CONCLUSION: Compensatory hyperhidrosis is a very common postoperative side effect after videothoracic sympathectomy, occurring early after the procedure and persisting for prolonged periods of time. The most frequently affected body area is the back, and no concordance between objective and subjective assessments was observed.

PMID:34411664 | DOI:10.1016/j.avsg.2021.05.014

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A survey of long-term results with microwave energy device for treating axillary hyperhidrosis

J Cosmet Laser Ther. 2021 Aug 19:1-3. doi: 10.1080/14764172.2021.1957115. Online ahead of print.

ABSTRACT

Microwave energy technology treats axillary hyperhidrosis through thermolysis of the apocrine and eccrine glands. Successful short-term reduction of sweating has been studied, but there is limited information on long-term efficacy and safety. To evaluate patient satisfaction with microwave energy device for axillary hyperhidrosis performed within the last 5 years. From June to August 2019, a standardized telephone survey was conducted of 24 patients who received microwave energy device treatment for bilateral axillary hyperhidrosis between June 2014 and June 2018. Demographic information, previous treatment modalities, sweat reduction scores, and side effects were reported. Eighteen patients completed the survey with a mean follow-up of 38 months (range 12-52). The mean hyperhidrosis disease severity scale (HDSS) was reduced by 1.6 (95% CI 1.2-2.0, p < .01). The mean sweat reduction was 61-70%. Sixty-seven percent of patients experienced a reduction in odor and 54% did not require deodorant after treatment. Adverse effects included bruising (67%), pain (56%), swelling (44%), numbness (28%), and nodules (22%). Sixty-six percent of side effects resolved within 2 weeks and all side effects resolved within 12 weeks. The microwave energy device is an effective, durable therapy for axillary hyperhidrosis associated with minimal downtime and a high degree of long-term patient satisfaction.

PMID:34409892 | DOI:10.1080/14764172.2021.1957115

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Measurement properties of patient-reported outcome measures (PROMs) in hyperhidrosis: a systematic review

Qual Life Res. 2021 Jul 30. doi: 10.1007/s11136-021-02958-3. Online ahead of print.

ABSTRACT

PURPOSE: To critically appraise, compare and summarize the quality of all existing PROMs that have been validated in hyperhidrosis to at least some extend by applying the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. Thereby, we aim to give a recommendation for the use of PROMs in future clinical trials in hyperhidrosis.

METHODS: We considered studies evaluating, describing or comparing measurement properties of PROMs as eligible. A systematic literature search in three big databases (MEDLINE, EMBASE and Web of Science) was performed. We assessed the methodological quality of each included study using the COSMIN Risk of Bias checklist. Furthermore, we applied predefined quality criteria for good measurement properties and finally, graded the quality of the evidence.

RESULTS: Twenty-four articles reporting on 13 patient-reported outcome measures were included. Three instruments can be further recommended for use. They showed evidence for sufficient content validity and moderate- to high-quality evidence for sufficient internal consistency. The methodological assessment showed existing evidence gaps for eight other PROMs, which therefore require further validation studies to make an adequate decision on their recommendation. The Hyperhidrosis Disease Severity Measure-Axillary (HDSM-Ax) and the short-form health survey with 36 items (SF-36) were the only questionnaires not recommended for use in patients with hyperhidrosis due to moderate- to high-quality evidence for insufficient measurement properties.

CONCLUSION: Three PROMs, the Hyperhidrosis Quality of Life Index (HidroQoL), the Hyperhidrosis Questionnaire (HQ) and the Sweating Cognitions Inventory (SCI), can be recommended for use in future clinical trials in hyperhidrosis. Results obtained with these three instruments can be seen as trustworthy. Nevertheless, further validation of all three PROMs is desirable.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020170247.

PMID:34327635 | DOI:10.1007/s11136-021-02958-3

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Thoracic sympathectomy for the treatment of primary axillary hyperhidrosis: systematic review and proportional meta-analysis

Ann Med. 2021 Dec;53(1):1216-1226. doi: 10.1080/07853890.2021.1953126.

ABSTRACT

INTRODUCTION: Primary hyperhidrosis is a disorder that involves excessive sweat production, which has a negative impact on the quality of life.

OBJECTIVE: To evaluate the effectiveness and safety of video-assisted thoracoscopic sympathectomy (VATS) for treating primary axillary hyperhidrosis (PAH) and determine which level of ganglion resection offers the best outcome.

METHOD: This was a systematic review and proportional meta-analysis of observational studies. The result was evaluated for satisfaction, control of symptoms, compensatory sweating and complications. A subgroup analysis was performed to compare the sympathetic trunk resection at high and low levels.

RESULTS: Thirteen studies were selected with a total of 1463 patients. The satisfaction rate was 92% (95% CI = 88-95%, I2=47.5%), the symptom control rate was 96% (95% CI = 93-99%, I2=48.2%), and the presence of compensatory sweating could not be assessed because of high heterogeneity among studies. The complications were rare.

CONCLUSION: This review demonstrated that thoracic sympathectomy by VATS is a viable and safe option for the treatment of PAH. There was no difference between high and lower levels of resection. However, the estimation of the effect is quite uncertain because the quality of evidence was extremely low.Key messagePure axillary hyperhidrosis has great potential to compromise quality of life.Surgery should be indicated only when clinical treatment fails.Thoracic sympathectomy by video-assisted thoracoscopy is a viable and safe option for the treatment of primary axillary hyperhidrosis.

PMID:34282698 | DOI:10.1080/07853890.2021.1953126

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Thoracoscopic sympathetic block to predict compensatory hyperhidrosis in primary hyperhidrosis

J Thorac Dis. 2021 Jun;13(6):3509-3517. doi: 10.21037/jtd-21-229.

ABSTRACT

BACKGROUND: Compensatory hyperhidrosis is the main cause of patients’ dissatisfaction following sympathectomy for primary hyperhidrosis. Therefore, thoracoscopic sympathetic nerve block before sympathectomy can be used to predict compensatory hyperhidrosis after sympathectomy. The objective of this study is to review our recent experience with the nerve block procedure, describing efficacy, safety and validity.

METHODS: We retrospectively reviewed the medical records of 107 patients who underwent thoracoscopic sympathetic nerve block with a local anesthetic for primary palmar and craniofacial hyperhidrosis using a 2-mm needlescope from March 2017 to November 2019. A week later, the patients were interviewed, and a decision made as to whether to proceed with sympathectomy. We analyzed the perioperative data of patients who underwent the predictive procedure either followed, or not followed, by sympathectomy.

RESULTS: Primary hyperhidrosis was relieved in all patients by the predictive procedure without severe complications. Compensatory hyperhidrosis happened to 32 patients (29.9%). Seventy-eight patients (72.9%) decided to undergo sympathectomy (group A) and 29 patients (27.1%) refused the sympathectomy (group B). Group B tended to have higher average body mass index (24.5 versus 23.2 kg/m2, P=0.082) and compensatory hyperhidrosis rate after predictive procedure (37.9% versus 26.9%, P=0.269) compared to group A. The compensatory hyperhidrosis rate after sympathectomy in group A was 76.9%. The effective duration of sympathetic block was significantly longer in group A than in group B (33.5 versus 13.9 hours, P=0.001). The predictive procedure had 94.4% specificity and 33.3% sensitivity for prediction of compensatory hyperhidrosis.

CONCLUSIONS: Thoracoscopic sympathetic block may be safe and feasible as a procedure for predicting compensatory hyperhidrosis after sympathectomy, and beneficially, it allows the patients to experience the effect of sympathectomy on primary hyperhidrosis and occurrence of compensatory hyperhidrosis. However, a longer effective duration of sympathetic block is needed to help patients to decide whether to proceed with the surgery.

PMID:34277046 | PMC:PMC8264690 | DOI:10.21037/jtd-21-229