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Transaxillary thoracic sympathectomy for primary hyperhidrosis of the upper limbs

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Abstract

Although a benign condition, primary hyperhidrosis of the upper limbs (palmar and axillary) may cause considerable psychological, social, and occupational disturbances. Definitive surgical treatment (i.e., upper dorsal sympathectomy) is justified after failure of conservative measures. Of the various surgical approaches to the upper thoracic sympathetic chain, one must select the approach that combines excellent results (cosmetic outcome included) with only minor and infrequent complications and side effects.

Our experience with 70 thoracic sympathectomies (initially performed through a wide thoracotomy, currently by the transaxillary approach) followed up for an average of 25 months (range 1–87 months), corresponds with these strict criteria: 94% completely dry hands; 86% total, and an additional 10% partial, subjective satisfaction with the results; minimal and relatively mild side effects and complications.

These results compare favorably with reports in the literature regarding thoracic sympathectomies performed through alternative approaches, indicating that the transaxillary approach is at least as good as the other approaches. At the same time, side effects and complications are less frequent and of a milder character with the transaxillary approach. We, therefore, recommend the axillary approach for thoracic sympathectomy in cases of hyperhidrosis of the upper limbs.

Résumé

Bien que bénigne, l'hyperhydrose primitive des membres supérieurs (palmaire et axillaire) peut entraîner des troubles psychologiques, sociaux et professionnels importants. Le traitement chirurgical de cette condition: sympathectomie dorsale haute est justifiée lorsque toutes les autres méthodes ont échoué.

Des différentes voies d'abord de la partie supérieure de la chaîne sympathique, il convient de retenir celle qui associe les meilleurs résultats (aspect esthétique inclus) et les risques de complications et d'effets indésirables les moins nombreux et les moins importants.

Notre expérience porte sur 70 sympathectomies qui furent d'abord pratiquées par une large voie d'abord thoracique puis ensuite par une voie axillaire, les malades étant suivis en moyenne pendant 25 mois, (allant de 1 à 87 mois). Les résultats ont été les suivants: 94% de mains complètement asséchées, cependant que les complications et les effets indésirables étaient minimes.

Ces résultats comparés avec ceux de la littérature en ce qui concerne les différentes voies d'abord de la partie supérieure de la chaîne thoracique indiquent que la voie axillaire que nous proposons donne des résultats au moins aussi bons que ceux obtenus par les autres voies d'abord alors même que les complications et les effets indésirables sont moins fréquents et moins graves.

En conclusion, nous recommandons la voie d'abord axillaire pour pratiquer la sympathectomie thoracique en cas d'hyperhydrose des membres supérieurs.

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Correspondence to Ahud Sternberg M.D..

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Sternberg, A., Brickman, S., Kott, I. et al. Transaxillary thoracic sympathectomy for primary hyperhidrosis of the upper limbs. World J. Surg. 6, 458–463 (1982). https://doi.org/10.1007/BF01657682

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Keywords

  • Cosmetic Outcome
  • Sympathetic Chain
  • Trouble Psychologiques
  • Subjective Satisfaction
  • Mild Side Effect