Hyperhidrosis: treatment, results, problems

Motus I.Ya.; Bazhenov A.V.

doi:https://doi.org/10.17116/hirurgia202107112

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OBJECTIVE

To analyze the results of thoracic sympathectomy for hyperhidrosis.

MATERIAL AND METHODS

The study included 166 patients aged from 15—51 years. There were 118 women and 48 men. Isolated palmar hyperhidrosis was observed in 46 patients, axillary — 46 patients, palmar-axillary — 74 cases. Video-assisted thoracic bilateral sympathectomy was performed. In patients with palmar hyperhidrosis, sympathetic chain was transected between the ribs II and III, axillary and palmar-axillary hyperhidrosis — between the ribs III and IV.

RESULTS

Intraoperative injury of intercostal artery occurred in 1 case. Cautery was effective. Postoperative complications occurred in 4 (2.4%) patients (pneumothorax followed by drainage for up to 2—3 days). Symptoms of hyperhidrosis disappeared early after surgery in all cases. Long-term results were followed in 47 patients. Persistent positive effect and patient satisfaction with postoperative outcome were noted in 44 (93.6%) cases. Recurrences occurred in 2 patients with palmar hyperhidrosis and 1 patient with axillary hyperhidrosis for the period from 2 weeks to 6 months. Compensatory sweating developed in 26 (55.3%) patients (within several weeks up to 6 months). Mild compensatory sweating occurred in 17 patients, moderate — 8 patients, severe — 1 patient. Compensatory sweating was more common in patients with axillary and palmar-axillary hyperhidrosis compared to those with isolated palmar hyperhidrosis (p<0.05). We found no significant difference in the incidence of compensatory sweating depending on the level of sympathetic chain intersection (p>0.05).

CONCLUSION

An effectiveness of thoracic sympathectomy for hyperhidrosis is obvious. Compensatory sweating is the main undesirable consequence of this surgery. Prediction and prevention of compensatory sweating are not possible. It is imperative to warn the patient about possible compensatory sweating.

Keywords:

hyperhidrosis

videothoracoscopy

thoracic sympathectomy

results

Authors:

Motus I.Ya.

Ural Research Institute for Phthisiopulmonology

ORCID: 0000-0002-3092-6504

Bazhenov A.V.

Ural Research Institute for Phthisiopulmonology

Received:

23.08.2020

Accepted:

13.09.2020

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References:

de Campos JRM, Kauffman P, Werebe Ede C, Andrade Filho LO, Kusniek S, Wolosker N, Jatene FB. Quality of life, before and after thoracic sympathectomy: report on 378 operated patients. Ann Thorac Surg. 2003;76(3):886-891. https://doi.org/10.1016/s0003-4975(03)00895-6
Vannucci F, Araujo JA. Thoracic sympathectomy for hyperhidrosis: from surgical indications to clinical results. J Thorac Dis. 2017;9(suppl 3):178-192. https://doi.org/10.21037/jtd2-17.04.04
Ro KM, Cantor RM, Lange KL, Ahn SS. Palmar hyperhidrosis: Evidence of genetic transmission. J Vasc Surg. 2002;35:382-386. https://doi.org/10.1067/mva.2002.119507
Cerfolio RJ, de Campos JR, Bryant AS, Connery CP, et al. The Society of Thoracic Surgeons Expert Consensus for the Surgical Treatment of Hyperhidrosis. Ann Thorac Surg. 2011;91:1642-1648. https://doi.org/10.1016/j.athoracsur.2011.01.105
Gunn TM, Davis DM, Speicher JE, Rossi NP et al. Expanded level of sympathetic chain removal does not increase the incidence or severity of compensatory hyperhidrosis after endoscopic thoracic sympathectomy. J Thorac Cardiovasc Surg. 2014;148:2673-2676. https://doi.org/10.1016/j.jtcvs.2014.06.080
Li DC, Hubert A, Waldbaum B, Ober C, Hooker CM, Huang P et al. Endoscopic thoracic sympatectomy for primary focal hyperhidrosis: impact on psycho-social symptomatology and psychotropic medication use. Eur J Cardiothorac Surg. 2018;54:904-911. https://doi.org/10.1093/ejcts/ezy211
Naumann M, Lowe NJ, Kumar CR, Hamm H. Botulinum toxin type a is a safe and effective treatment for axillary hyperhidrosis over 16 months: a prospective study. Arch Dermatol. 2003;139:731-736. 11 https://doi.org/10.1001/archderm.139.6.731
Coelho MS, Caetano Silva RFK, Mezzalira J, Neto NB, et al. T3T4 Endoscopic Sympathetic Blockade Versus T3T4 Video Thoracoscopic Sympathectomy in the Treatment of Axillary Hyperhidrosis. Ann Thorac Surg. 2009;88:1780-1785. https://doi.org/10.1016/j.athoracsur.2009.08.007
Batyrshina SV, Khaertdinova LA. Hyprhidrosis: a method for correction. Prakticheskaya meditsina. 2008;8(84):16-23. (In Russ.).
Pinson IYa, Olisova OYu, Verkhoglyad IV. High frequency therapy of primary axillary hyperhidrosis. Russian journal of skin and veneral diseases. 2016;19(4):245-248. (In Russ.). https://doi.org/10.18821/1560-9588-2016-19-4-245-248
Ambrogi V, Campione E, Mineo D, Paterno EJ, et al. Bilateral Thoracoscopic T2 to T3 Sympathectomy Versus Botulinum Injection in Palmar Hyperhidrosis. Ann Thorac Surg. 2009;88:238-245. https://doi.org/10.1016/j.athoracsur.2009.04.003
Dumont P, Denoyer A, Robin P. Long-Term Results of Thoracoscopic Sympathectomy for Hyperhidrosis. Ann Thorac Surg. 2004;78:1801-1807. https://doi.org/10.1016/j.athoracsur.2004.03.012
Licht PB, Pilegaard HK. Severity of compensatory sweating after thoracoscopic sympathectomy. Ann Thorac Surg. 2004;78(2):427-431. https://doi.org/10.1016/j.athoracsur.2004.02.087
Doolabh N, Horswell S, Williams M, Huber L, et.al. Thoracoscopic sympathectomy for hyperhidrosis: indications and results. Ann Thorac Surg. 2004;77(2):410-414. https://doi.org/10.1016/j.athoracsur.2003.06.003
Lin TS, Kuo SJ, Chou MC. Uniportal endoscopic thoracic sympathectomy for treatment of palmar and axillary hyperhidrosis: analysis of 2000 cases. Neurosurgery. 2002;51(5 suppl):84-87.
Chou SH, EL Kao, Lin CC, Chang YT, Huang MF. The importance of classification in sympathetic surgery and a proposed mechanism for compensatory hyperhidrosis: experience with 464 cases. Surg Endosc. 2006;20:1749-1753. https://doi.org/10.1007/s00464-005-0829-7
Leao LE, de Oliveira R, Szulc R, Mari Jde J, et al. Role of video-assisted thoracoscopic sympathectomy in the treatment of primary hyperhidrosis. Sao Paulo Med J. 2003;121(5):191-197. https://doi.org/10.1590/s1516-31802003000500003
Leseche G, Castier Y, Thabut G, Petit MD et al. Endoscopic transthoracic sympathectomy for upper limb hyperhidrosis: limited sympathectomy does not reduce postoperative compensatory sweating. J Vasc Surg. 2003;37(1):124-128. https://doi.org/10.1067/mva.2002.23
Miller DL, Bryant AS, Force SD, Miller JI Effect of sympathectomy level on the incidence of compensatory hyperhidrosis after sympathectomy for palmar hyperhidrosis. J Thorac Cardiovasc Surg. 2009;138(3):581. https://doi.org/10.1016/j.jtcvs.2009.03.059
Li X, Tu Y, Lin M, Fan-Cai L, Chen J, Dai Z. Endoscopic thoracic sympathectomy for palmar hyperhidrosis: a randomized control trial comparing T3 and T2-4 ablation. Ann Thorac Surg. 2008;85:1747-1751. https://doi.org/10.1016/j.athoracsur.2008.01.060
Lin TS. Video-assisted thoracoscopic «resympathectomy» for palmar hyperhidrosis: analysis of 42 cases. Ann Thorac Surg. 2001;72:895-898. https://doi.org/10.1016/s0003-4975(01)02852-1
Cho HM, Lee DY, Sung SW. Anatomical variations of rami communicantes in the upper thoracic sympathetic trunk. Eur J Cardiothorac Surg. 2005;273:20-324. https://doi.org/10.1016/j.ejcts.2004.10.057
Ramsaroop L, Singh B, Moodley J, Partab P, Satyapal KS. Anatomical basis for a successful upper limb sympathectomy in the thoracoscopic era. Clin Anat. 2004;17:294-299. https://doi.org/10.1002/ca.10238
Licht PB, Clausen A, Ladegaard L. Resympathicotomy. Ann Thorac Surg. 2010;89:1087-1090. https://doi.org/10.1016/j.athoracsur.2010.01.005
Yazbek G, Wolosker N, Kauffman P, de Campos JRM, et al. Twenty Months of Evolution Following Sympathectomy on Patients with Palmar Hyperhidrosis: Sympathectomy at the T3 Level is Better than at the T2 Level. Clinics (Sao Paulo). 2009;64(8):743-749. https://doi.org/10.1590/S1807-59322009000800006
Gossot D, Galetta D, Pascal A, Debrosse D. Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis. Ann Thorac Surg. 2003;75(4):1075-1079. https://doi.org/10.1016/s0003-4975(02)04657-x
Schmidt J, Bechara FG, Altmeyer P, Zirngibl H. Endoscopic thoracic sympathectomy for severe hyperhidrosis: impact of restrictive denervation on compensatory sweating. Ann Thorac Surg. 2006;81(3):1048-1055. https://doi.org/10.1016/j.athoracsur.2005.09.046.
Liu Y, Yang J, Liu J, Yang F, et al. Surgical treatment of primary palmar hyperhidrosis: a prospective randomized study comparing T3 and T4 sympathicotomy. Eur J Cardiothorac Surg. 2009;35:398-402. https://doi.org/10.1016/j.ejcts.2008.10.048
Munia MAS, Wolosker N, Kaufmann P, de Campos JRM, Puech-Leão P. Sustained benefit lasting one year from T4 Instead of T3-T4 sympathectomy for isolated axillary hyperhidrosis. Clinics (Sao Paulo). 2008;63:771-774. https://doi.org/10.1590/s1807-59322008000600011
Sugimura H, Spratt EH, Compeau CG, Kattail D. et al. Thoracoscopic sympathetic clipping for hyperhidrosis: Long-term results and reversibility. Thorac Cardiovasc Surg. 2009;137:1370-1378. https://doi.org/10.1016/j.jtcvs.2009.01.008.