Long-Term Results of Thoracic Sympathectomy for Primary Hyperhidrosis
Languages of publication
The side effects following thoracic sympathectomy for primary hyperhidrosis include pain and compensatory/ reflex sweating.The aim of the study was the evaluation of the results of the endoscopic sympathicotomy with clips with emphasis on the frequency of side effects following the operation.Material and methods. Two-hundred-eighty-three patients were qualified to thoracic T3-T4 sympathicotomy with clips. In all cases bilateral procedure in prone position with CO2 insufflation was performed. The subjective intensity of disease was evaluated by VAS scale (0 - no sweating; 10 - maximal possible sweating) while the recurrence of the sweating in primary localization, intensity and dynamics of compensatory and plantar sweating were evaluated post-operatively. Follow-up data were obtained during office visits 3, 12 and 36 months after surgery. The overall follow-up response was 74.6%.Results. There was no mortality. Perioperative morbidity included 6 cases of pneumothorax. The mean duration of surgery was 57 minutes bilaterally. The postoperative intercostal pain was present in all patients (100%) with mean duration of 21.88 days but in 72.6% of cases it did not demand any medication as early as 48 hours after surgery. Strong or very strong compensatory sweating was observed in 17.5% of cases 3 months after ETS, in 14.1% after 12 months and in 23.6% after 36 months.Conclusions. Thoracic sympathicotomy with clips is a safe treatment that provides satisfactory longterm results. The incidence of side-effects (intercostal pain, compensatory sweating) is high and does not change with time in most of the cases.
1 - 05 - 2013
12 - 06 - 2013
- Department of General, Endocrine and Transplant Surgery, Medical University in Gdańsk
- LOPSAP, Laboratory for Psychology of Surgery and Psychosomatics, Department of General, Endocrine and Transplant Surgery, Medical University in Gdańsk. Kierownik obydwu zakładów: prof. dr hab. Z. Śledziński
- 1. Haider A, Solish N: Focal hyperhidrosis: diagnosis and management. CMAJ 2005; 172(1): 69-75.
- 2. Strutton DR, Kowalski JW, Glaser DA, StangPE: US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey. J Am Acad Dermatol 2004; 51(2): 241-48.[PubMed][Crossref]
- 3. Vazquez LD, Staples NL, Sears SF, Klodell CT : Psychosocial functioning of patients after endoscopic thoracic sympathectomy. Eur J CardiothoracSurg 2011; 39(6): 1018-21.[Crossref]
- 4. Swaile DF, Elstun LT, Benzing KW : Clinical studies of sweat rate reduction by an over-thecounter soft-solid antiperspirant and comparison with a prescription antiperspirant product in male panelists. Br J Dermatol 2012; 166 Suppl 1: 22-26.[WoS]
- 5. Lowe N, Campanati A, Bodokh I et al.: The place of botulinum toxin type A in the treatment of focal hyperhidrosis. Br J Dermatol 2004; 151(6): 1115-22.
- 6. Reisfeld R, Berliner KI : Evidence-based review of the nonsurgical management of hyperhidrosis. Thorac Surg Clin 2008; 18(2): 157-66.[Crossref][PubMed]
- 7. Stefaniak T, Pirski M, Osęka T et al.: Simultaneous bilateral transthoracic sympathectomy through posterior access in Lin-Telaranta modification for primary hyperhidrosis. Videosurg miniinv 2009: 4(2): 47-52.
- 8. Reisfeld R, Nguyen R, Pnini A: Endoscopic thoracic sympathectomy for treatment of essential hyperhidrosis syndrome: experience with 650 patients. Surg Laparosc Endosc Percutan Tech 2000; 10(1): 5-10.[PubMed]
- 9. Cameron AE : Complications of endoscopic sympathectomy. Eur J Surg Suppl 1998; (580): 33-35.
- 10. Cramer MN, Jay O: Compensatory hyperhidrosis following thoracic sympathectomy: a biophysical rationale. Am J Physiol Regul Integr Comp Physiol 2012; 302(3): R352-6
- 11. Jaffer U, Weedon K, Cameron AE : Factors affecting outcome following endoscopic thoracic sympathectomy. Br J Surg 2007; 94(9): 1108-12.[Crossref]
- 12. Stefaniak T, Proczko-Markuszewska M, RoytonA et al.: Importance of objective evaluation of sweating in qualification and follow-up of primary hyperhidrosis patients undergoing sympathectomy. Intl. Symposium on Sympathetic Surgery, Odense, Denmark, 2011, June 17-19th: final program, Abs. P-5.
- 13. Stefaniak T, Proczko-Markuszewska M: Gravimetry in sweating assessment in primary hyperhidrosis and healthy individuals - brief communication. CAR (in press)
- 14. Stefaniak T, Laski D. Stefaniak T et al.: In the search for the treatment of compensatory swe- ating. Scientific World Journal 2012; 2012: 1345-47.[WoS]
- 15. Hund M, Kinkelin I, Naumann M, Hamm H: Definition of axillary hyperhidrosis by gravimetric assessment. Arch Dermatol 2002; 138(4): 539-41.
- 16. Heckmann M, Ceballos-Baumann AO , PlewigG: Hyperhidrosis Study Group. Botulinum toxin A for axillary hyperhidrosis (excessive sweating). N Engl J Med 2001; 344(7): 488-93.
- 17. Sugimura H, Spratt EH, Compeau CG et al.: Thoracoscopic sympathetic clipping for hyperhidrosis: long-term results and reversibility. J ThoracCardiovasc Surg 2009; 137(6): 1370-76.
- 18. Ibrahim M, Menna C, Andreetti C et al.: Twostage unilateral versus one-stage bilateral singleport sympathectomy for palmar and axillary hyperhidrosis. Interact Cardiovasc Thorac Surg 2013. (Epub ahead of print).
- 19. Currie AC , Evans JR, Thomas PR: An analysis of the natural course of compensatory sweating following thoracoscopic sympathectomy. Int J Surg 2011; 9(5): 437-39. doi: 10.1016/j.ijsu.2011.04.006.[Crossref][WoS][PubMed]
- 20. Araújo CA , Azevedo IM, Ferreira MA et al.: Compensatory sweating after thoracoscopic sympathectomy: characteristics, prevalence and influence on patient satisfaction. J Bras Pneumol 2009; 35(3): 213-20.[WoS]
- 21. Stefaniak T, Vingerhoets A, Proczko-MarkuszewskaM: The importance of quantitative evaluation in the follow-up after sympathectomy for primary hyperhidrosis. Clin Auton Res 2007; 17(2): 122-23.[PubMed][WoS][Crossref]
- 22. Stefaniak TJ: Erytrofobia - problemy diagnostyki i leczenia. Pol Przegl Chir 2012; 84(6): 559-69.
- 23. Stefaniak T, Cwigon M: Long-term results of treatment of primary hyperhidrosis with thoracic sympathectomy in Lin-Telaranta modification. PolPrzegl Chir 2011; 83, supl.1: S.12
- 24. Loscertales J, Congregado M, Jimenez-MerchanR et al.: Sympathetic chain clipping for hyperhidrosis is not a reversible procedure. Surg Endosc 2012; 26(5): 1258-63.[Crossref]
Publication order reference