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Optimization of sympathectomy to treat palmar hyperhidrosis: the systematic review and meta-analysis of studies published during the past decade

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Abstract

Objective

The systemic review and meta-analysis of the studies published during the past 10 years was designed to optimize the surgical procedures of video-assisted thoracoscopic sympathectomy (VTS) to treat palmar hyperhidrosis (PH).

Methods

Citations from 2000 to 2010 were included regarding the following aspects: selection of ganglia level for VTS, comparison of different techniques for VTS, evaluating clinical efficacy of intraoperative intrapleural analgesia, and postoperative intrapleural drainage. Major clinical outcomes are defined as: cases with postoperative resolution of symptoms, total cases with postoperative compensatory hyperhidrosis (CH), cases with severe or moderate CH, satisfied cases, evaluation of postoperative pain, and postoperative pneumothorax.

Results

Systemic review indicates that T3 and T3–4 sympathectomy had the “best” clinical efficacy. Meta-analysis suggests that efficacious rates of PH are nearly similar compared with multiple and single ganglia sympathectomy (100 vs. 95.6%). However, single-ganglia sympathectomy can render a lower risk of total CH compared with multiple-ganglia block. Risk of moderate/severe CH has a similar trend. Additionally, single-ganglia sympathectomy is more potent to satisfy patients postoperatively. One randomized, controlled trial (RCT) that compared different techniques for VTS indicated that the overall success rate of the operation was 95% and the differences were not statistically significant. Two RCTs indicated that there were significant differences between trial group (intraoperative intercostal nerve blocks using bupivacaine) and control group regarding the attenuation of postoperative pain. One RCT suggested that there was no significant difference with or without pleural drainage regarding the incidence of postoperative residual pneumothorax.

Conclusions

T3 sympathectomy is supposed to be recommended for the treatment of PH regardless of using various techniques. Intraoperative intrapleural analgesia using bupivacaine or bupivacaine plus epinephrine is effective to prevent postoperative pain. Pleural drainage after VTS should be abandoned.

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Disclosures

Drs. Bo Deng, Qun-You Tan, Ru-Wen Wang, Yao-Guang Jiang, Yun-Ping Zhao, Jing-Hai Zhou and Zheng Ma have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Changjiang Branch St. 10#, Yuzhong District, Chongqing City, 400042, People’s Republic of China

    Bo Deng, Qun-You Tan, Yao-Guang Jiang, Yun-Ping Zhao, Jing-Hai Zhou, Zheng Ma & Ru-Wen Wang

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  1. Bo Deng
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Correspondence to Ru-Wen Wang.

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The authors wish it to be known publicly that the first two authors (Bo Deng and Qun-You Tan) should be regarded as joint first authors.

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Deng, B., Tan, QY., Jiang, YG. et al. Optimization of sympathectomy to treat palmar hyperhidrosis: the systematic review and meta-analysis of studies published during the past decade. Surg Endosc 25, 1893–1901 (2011). https://doi.org/10.1007/s00464-010-1482-3

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