Thoracic sympathicolysis for primary hyperhidrosis
- 90 Downloads
Bilateral upper thoracic sympathectomy or sympathicolysis, currently the standard treatment for palmar or axillary hyperhidrosis, is regarded as a safe procedure. This study evaluates the quantitative and qualitative incidence of intraoperative and postoperative complications resulting from bilateral thoracic sympathicolysis.
From 1996 to 2004, 458 consecutive patients with primary hyperhidrosis underwent surgery. These patients comprised 143 men (31.2%) and 315 women (68.7%) with a mean age of 26 years (range, 14–52 years). In all but seven cases, the procedure was bilaterally synchronous.
No mortality was recorded. The anhydrosis rate was 97.4%, with a hypohidrosis rate of 2.4% and a failure rate of 0.2%. The latter was resolved with reintervention. The mean hospital stay was 17 h. The rate of major perioperative complications with conversion to thoracotomy was 0.4%. The overall rate of postoperative complications was 3.6%. The complications and rates observed were as follows: pneumothorax (2.06%), subcutaneous emphysema (1.08%), pleural bleeding (0.2%), hemothorax (0.1%), and atelectasis (0.1%). Compensatory hyperhidrosis was observed in 48.4% of the patients, but the sensation of compensatory hyperhidrosis was reported in 85.6% of the cases. Excessive dryness of the hands was reported in 0.38%, Horner’s syndrome in 0.32%, and gustatory hyperhidrosis in 1.1% of the cases. The overall satisfaction rate was 88.5%.
The results suggest that endoscopic bilateral thoracic sympathicolysis is an effective method for managing primary hyperhidrosis, especially severe palmar hyperhidrosis, but it is necessary to inform patients fully concerning the undesirable effects.
KeywordsHemothorax Hyperhidrosis Sympathectomy Video-assisted thoracic surgery (VATS)
- 1.Adar R (1994) Surgical treatment of palmar hyperhidrosis before thoracoscopy: experience with 475 patients. Eur J Surg 572(Suppl): 9–11Google Scholar
- 9.Hederman WP (1994) Present and future trends in thoracoscopic sympathectomy. Eur J Surg 572(Suppl): 17–19Google Scholar
- 11.Hyndman OR, Wolkin J (1942) Sympathectomy of the upper extremity: evidence that only the second dorsal ganglion need be removed for complete sympathectomy. Arch Surg 45: 145–155Google Scholar
- 19.Lin CC, Mo LR, Lee SM, Ng SM, Hwang MH (1998) Thoracoscopic T2-sympathectomy block by clipping: a better and reversible operation for treatment of hyperhidrosis palmaris: experience in 326 cases. Eur J Surg 64: 13–16Google Scholar
- 20.Lin TS, Fang HY (2000) Transthoracic endoscopic sympathectomy in the treatment of palmar hyperhidrosis with emphasis on perioperative management (1,360 case analyses). Surg Neurol 52: 453–457 Google Scholar
- 21.Moya J, Ferrer G, Morera R, Pujol R, Ramos R, Villalonga R, Bernat R (2001) Estudio comparativo entre gangliectomía y la simpaticolisis torácica superior para el tratamiento quirúrgico de la hiperhidrosis palmar primaria: a propósito de 185 procedimientos en 100 pacientes. Actas Dermosifiliogr 92: 369–375Google Scholar
- 22.Moya J, Ferrer G, Peyrí J, Pujol R, Morera R, Tarrado X, Villalonga R (2000) Simpatectomía torácica endoscópica en el tratamiento de la hiperhidrosis palmar primaria: a propósito de 28 casos. Actas Dermosifiliogr 91: 43–46Google Scholar
- 25.Ramos R, Moya J, Pérez J, Villalonga R, Morera R, Pujol R,Ferrer G (2003) Primary hyperhidrosis: prospective study in 338 patients. Med Clin (Barc) 121: 201–203Google Scholar
- 29.Selley WB, Florence R (1960) Compensatory hyperhidrosis of sympathectomy. N Engl J Med 263: 1056–1058Google Scholar
- 31.Wittmoser R (1994) Sympathectomies et vagotomies par thoracoscopie. In: Gossot D (ed) Techniques de chirurgie endoscopique du thorax. Springer-Verlag, Paris pp 168–189Google Scholar
- 33.Yoon H, Ha Y, Park YG, Chang JW (2003) Thoracoscopic limited T3 sympathectomy for primary hyperhidrosis: prevention for compensatory hyperhidrosis. J Neurosurg 99(Suppl 1): 39–43Google Scholar