Skip to main content

Advertisement

SpringerLink
Log in

Thoracoscopic resympathectomy for persistent or recurrent palmar hyperhidrosis: single-center experience

  • Original Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Background

In case of recurrence or persistent palmar hyperhidrosis, a sympathetic chain resection is suggested, however, many surgeons are still reluctant to offer further intervention because of the inability to predict the efficacy of such a procedure. We analyzed our large series of resympathectomy.

Methods

Substantive retrospective analysis of 39 patients underwent a resympathectomy (minimally invasive bilaterally sympathetic chain Th2-3 resection). Patients referred from other hospitals or primarily operated at our institution for recurrence or persistence palmar hyperhidrosis were included in the study group.

Results

No intraoperative complications were detected. Reoperation or chest tube positioning was necessary in 2 patients. Twenty-eight patients had a positive response (excellent or good results). Seven patients described a substantial, but not sufficient, reduction of the symptomatology. Four patients were very unsatisfied and regretted the operation.

Conclusions

Resympathectomy is highly effective procedure for patients who have persistent or recurrent symptoms. However, the indication of the operations should be more dissuasive as possible to avoid the risk of any undesirable psychologically side effects.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Availability of data and material

All data are freely available for review.

Code availability

Not applicable.

References

  1. Strutton DR, Kowalski JW, Glaser DA, Stang PEJ. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey. Am Acad Dermatol. 2004;51:241–8.

    Article  Google Scholar 

  2. Ibrahim M, Menna C, Andreetti C, Ciccone AM, D’Andrilli A, Maurizi G. Bilateral single-port sympathectomy: long-term results and quality of life. Biomed Res Int. 2013;2013:348017.

    PubMed  PubMed Central  Google Scholar 

  3. Freeman RK, Van Woerkom JM, Vyverberg A, Ascioti AJ. Reoperative endoscopic sympathectomy for persistent or recurrent palmar hyperhidrosis. Ann Thorac Surg. 2009;88(2):412–6 (discussion 416–7).

    Article  Google Scholar 

  4. Lin TS. Video-assisted thoracoscopic ‘resympathicotomy’ for palmar hyperhidrosis: analysis of 42 cases. Ann Thorac Surg. 2001;72:895–8.

    Article  CAS  Google Scholar 

  5. Lin TS, Fang HY, Wu CY. Repeat transthoracic endoscopic sympathectomy for palmar and axillary hyperhidrosis. Surg Endosc. 2014;14:134–6.

    Article  Google Scholar 

  6. Kim DH, Paik HC, Lee DY. Video assisted thoracoscopic re-sympathetic surgery in the treatment of re-sweating hyperhidrosis. Eur J Cardiothorac Surg. 2005;27:741–4.

    Article  Google Scholar 

  7. Hsu CP, Chen CY, Hsia JY, Shai SE. Resympathectomy for palmar and axillary hyperhidrosis. Br J Surg. 1998;85:1504–5.

    Article  CAS  Google Scholar 

  8. Amir M, Arish A, Weinstein Y, Pfeffer M, Levy Y. Impairment in quality of life among patients seeking surgery for hyperhidrosis (excessive sweating): preliminary results. Isr J Psychiatry Relat Sci. 2000;37:25–31.

    CAS  PubMed  Google Scholar 

  9. Lin T-S. Video-Assisted Thoracoscopic “Resympathicotomy” for Palmar Hyperhidrosis: Analysis of 42 Cases. Ann Thorac Surg. 2001;72(3):895–8.

    Article  CAS  Google Scholar 

  10. de Campos JRM, Lembrança L, Fukuda JM, Kauffman P, Teivelis MP, Puech-Leão P, Wolosker N. Evaluation of patients who underwent resympathectomy for treatment of primary hyperhidrosis. Interact Cardiovasc Thorac Surg. 2017;25(5):716–9.

    Article  Google Scholar 

  11. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.

    Article  Google Scholar 

  12. de Campos JR, Kauffman P, Werebe EC, Kusniek S, Wolosker N, Biscegli JF. Quality of life, before and after thoracic sympathectomy: report on 378 operated patients. Ann Thorac Surg. 2003;76:886e91.

    Google Scholar 

  13. Cerfolio RJ, De Campos JRM, Bryant AS, Connery CP, Miller DL, DeCamp MM, McKenna RJ, Krasna MJ. The society of thoracic surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg. 2011;91:1642–8.

    Article  Google Scholar 

  14. Finlay AY, Khan GK. The Dermatology Life Quality Index: A simple practical measure for routine clinical use. British Association of Dermatologists Annual Meeting, Oxford, July 1993. Br J Dermatol. 1993;129(Suppl 42):27.

    Google Scholar 

  15. Rzany B., Bechara F.G., Feise K., Heckmann M., Rapprich S., Wörle B.. Aktualisierung der S1 Leitlinie zur Definition und Therapie der primären Hyperhidrose AWMF-Register Nr. 013/059 Klasse: S1 Aktualisierung Stand: 01.11.2017 Freigabe durch die Deutsche Dermatologische Gesellschaft (DDG): 27.11.2017.

  16. Fibla JJ, Molins L. Sympathetic disorders of the upper limbs. In: ESTS Textbook of Thoracic Surgery, Vol. 2, 2015, pp. 35–43. Kuzdzal J. (editor.) Asamura H, Detterbeck F., Godstraw P., Lerut A., Thomas P., Treasure T. (associate editors)

  17. Soares TJ, Dias PG, Sampaio SM. Impact of Video-Assisted Thoracoscopic Sympathectomy and Related Complications on Quality of Life According to the Level of Sympathectomy. Ann Vasc Surg. 2020;63:63–7.

    Article  Google Scholar 

  18. Cai S, Huang S, An J, Li Y, Weng Y, Liao H, Chen H, Liu L, He J, Zhang J. Effect of lowering or restricting sympathectomy levels on compensatory sweating. Clin Auton Res. 2014;24(3):143–9.

    Article  Google Scholar 

  19. Cheng A, Johnsen H, Chang MY. Patient satisfaction after thoracoscopic sympathectomy for palmar hyperhidrosis: do method and level matter? Perm J. 2015;19(4):29–31.

    PubMed  PubMed Central  Google Scholar 

  20. Inan K, Goksel OS, Uçak A, Temizkan V, Karaca K, Ugur M, Arslan G, Us M, Yılmaz AT. Thoracic endoscopic surgery for hyperhidrosis: comparison of different techniques. Thorac cardiovasc Surg. 2008;56(4):210–3.

    Article  CAS  Google Scholar 

  21. Wolosker N, Leiderman DB, de Campos JR, Kauffman P, Tedde ML, Yazbek G, Puech-Leão P. Number of preoperative hyperhidrosis sites does not affect the sympathectomy postoperative results and compensatory hyperhidrosis occurrence. Thorac Cardiovasc Surg. 2019;67(5):407–14.

    Article  Google Scholar 

  22. Loscertales J, Congregado M, Jimenez-Merchan R, Gallardo G, Trivino A, Moreno S, Loscertales B, Galera-Ruiz H. Sympathetic chain clipping for hyperhidrosis is not a reversible procedure. Surg Endosc. 2012;26(5):1258–63.

    Article  Google Scholar 

  23. Thomsen LL, Mikkelsen RT, Derejko M, Schrøder HD, Licht PB. Sympathetic block by metal clips may be a reversible operation. Interact Cardiovasc Thorac Surg. 2014;19(6):908–13.

    Article  Google Scholar 

  24. Hynes CF, Yamaguchi S, Bond CD, Marshall MB. Reversal of sympathetic interruption by removal of clips. Ann Thorac Surg. 2015;99(3):1020–3.

    Article  Google Scholar 

  25. Licht PB, Clausen A, Ladegaard L. Resympathicotomy. Ann Thorac Surg. 2010;89(4):1087–90.

    Article  Google Scholar 

  26. Singh B, Moodley J, Ramdial PK, Ramsaroop L, Satyapal KS. Pitfalls in thoracoscopic sympathectomy: mechanisms for failure. Surg Laparosc Endosc Percutan Tech. 2001;11(6):364–7.

    Article  CAS  Google Scholar 

  27. Singh B, Moodley J, Haffejee AA, Ramdial PK, Robbs JV, Rajaruthnam P. Resympathectomy for sympathetic regeneration. Surg Laparosc Endosc. 1998;8(4):257–60.

    Article  CAS  Google Scholar 

  28. Lin CC, Mo LR. Experience in thoracoscopic sympathectomy for hyperhidrosis with concomitant pleura adhesion. Surg Laparosc. 1996;6:258–61.

    Article  CAS  Google Scholar 

  29. Qian K, Feng YG, Zhou JH, Wang RW, Tan QY, Deng B. Anxiety after Sympathectomy in patients with primary palmar hyperhidrosis may prolong the duration of compensatory hyperhidrosis. J Cardiothorac Surg. 2018;13(1):54.

    Article  Google Scholar 

  30. Wang HY, Zhu YJ, Liu J, Li LW, Liu YH. The relationship between preoperative psychological evaluation and compensatory sweating. J Cardiothorac Surg. 2018;13(1):42.

    Article  Google Scholar 

  31. Lee DY, Paik HC, Kim DH, Kim HW. Comparative analysis of T3 selective division of rami communicantes (ramicotomy) to T3 sympathetic clipping in treatment of palmar hyperhidrosis. Clin Auton Res. 2003;13(Suppl 1):I45–7.

    PubMed  Google Scholar 

  32. Crandall CG, Meyer DM, Davis SL, Dellaria SM. Palmar skin blood flow and temperature responses throughout endoscopic sympathectomy. Anesth Analg. 2005;100(1):277–83.

    Article  Google Scholar 

  33. Sáiz-Sapena N, Vanaclocha V, Panta F, Kadri C, Torres W. Operative monitoring of hand and axillary temperature during endoscopic superior thoracic sympathectomy for the treatment of palmar hyperhidrosis. Eur J Surg. 2000;166(1):65–9.

    Article  Google Scholar 

Download references

Funding

We did not require any type of funding.

Author information

Authors and Affiliations

  1. Department of General, Visceral and Thoracic Surgery, Landeskrankenhaus Feldkirch, Carinagasse 47, 6807, Feldkirch, Austria

    Paolo N. C. Girotti, Martin Hufschmidt, Peter Tschann, Vebi Hodja, Daniel Lechner & Ingmar Königsrainer

Authors
  1. Paolo N. C. Girotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martin Hufschmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter Tschann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vebi Hodja
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel Lechner
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ingmar Königsrainer
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

PG, MH, VH, DL, and IK: data collection and writing of the manuscript.

Corresponding author

Correspondence to Paolo N. C. Girotti.

Ethics declarations

Conflict of interest

Paolo N.C. Girotti MD, Martin Hufschmidt MD, Peter Tschann MD, Vebi Hodja MD, Daniel Lechner MD, and Ingmar Königsrainer MD have no conflicts of interest.

Ethics approval

Approved by Vorarlberg Ethics Commission, Austria.

Consent to participate

Because of retrospective study, no written informed consent was obtained according to the regulations of the local ethics commission.

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Girotti, P.N.C., Hufschmidt, M., Tschann, P. et al. Thoracoscopic resympathectomy for persistent or recurrent palmar hyperhidrosis: single-center experience. Gen Thorac Cardiovasc Surg 70, 651–658 (2022). https://doi.org/10.1007/s11748-022-01788-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-022-01788-5

Keywords

Search

Navigation