Thoracic sympathicolysis for primary hyperhidrosis - A review of 918 procedures

Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907, Barcelona, Spain.
Surgical Endoscopy (Impact Factor: 3.26). 05/2006; 20(4):598-602. DOI: 10.1007/s00464-005-0557-z
Source: PubMed


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.

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    • "A previous report showed that ETS had a long-term effect on cardiac autonomic tone [7]. ETS is a therapeutic tool for palmer hyperhidrosis, reflex sympathetic dystrophy, circulatory disturbances of the upper extremities, and refractory angina in the presence of organic coronary stenosis [3] [4] [8] [9]. "
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    ABSTRACT: Although vasospastic angina (VSA) is usually controlled by medications, refractory or lethal cases are occasionally encountered. We performed bilateral endoscopic thoracic sympathectomy (ETS) in 5 male patients with refractory VSA. Prior to ETS, stellate ganglion blockade was performed in 4 patients to reduce VSA attacks and to confirm the effect of sympathetic blockade. Under endoscopic guidance, the second to fourth thoracic sympathetic ganglia were ablated with a YAG-laser. No patient had complications after ETS, including major sweating abnormalities. In 4 of 5 patients, ETS relieved all VSA symptoms. ST-segment elevation often detected before ETS was absent on repeated ambulatory 24-h Holter monitoring after ETS. ETS is an effective strategy for the treatment of refractory VSA.
    Full-text · Article · Aug 2008 · Journal of Cardiology
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    • "According to scientific literature, primary hyperhidrosis has an incidence of up to 1%, and the most widely currently applied treatment is surgery, which has been demonstrated to achieve the best outcome 2—6. The surgical procedure, endoscopic bilateral thoracic sympathicolysis (EBTS), is a simple, fast, effective and minimally invasive treatment [7] [8]. "
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    ABSTRACT: Endoscopic bilateral thoracic sympathicolysis (EBTS) is an effective and minimally invasive procedure used for patients with primary hyperhidrosis. The purpose of this study was to examine anxiety levels using standardized psychometric tools in hyperhidrosis patients before and after EBTS. A total of 106 patients diagnosed with hyperhidrosis who underwent EBTS were asked to fill out a questionnaire before and 12 months after the procedure that elicited the following information: (a) symptoms associated with hyperhidrosis; (b) the patient's level of anxiety; and (c) the extent to which this anxiety was incapacitating in their daily life. All patients also completed State-Trait Anxiety Inventory (STAI) before and 12 months after the EBTS. Palpitations were reported preoperatively by 40% of patients versus 10% postoperatively, trembling of the hands in 24% versus 8%, facial blushing in 55% versus 11%, headache in 29% versus 9%, and non-specific epigastric pain in 19% versus 7%. Patients reported a marked improvement in the level of anxiety from a mean SD of 2.08+/-1.1 preoperatively versus 0.39+/-0.67 postoperatively (p<0.001), and the social impact (debilitating) of primary hyperhidrosis before and after surgery also showed significant improvement (p<0.001). The results of STAI showed significant improvement in the levels of anxiety after surgery compared with the preoperative levels and with established norms (p<0.001). Patients with primary hyperhidrosis that undergo EBTS presented a decrease in the level of anxiety and associated symptoms.
    Full-text · Article · Sep 2006 · European Journal of Cardio-Thoracic Surgery
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    ABSTRACT: Background: While excessive sweating is considered by many to be a benign condition, the physical and psychosocial impact it can have on hyperhidrosis sufferers is not always fully appreciated. Methods: A retrospective review of our pharmacy's patient records with the presenting complaint of sweating was conducted. The review covered a 2-year span and consisted of 2517 records. Using a structured questionnaire, patient information was collected via e-mail, as well as telephone and face-to-face interviews by pharmacists. Patients described their difficulties and the different coping methods they would employ to alleviate or hide their excessive sweating on different areas such as the underarms, face/scalp, hands, feet, and torso/groin. Results: Underarm sweating is the most frequent area for which both male and female patients seek help, followed by hands, feet, and face/neck. For males over 40, face and neck sweating is the most frequent area of concern, whereas for females over 40, underarms remain a top priority. Patients report numerous instances of feeling isolated, depressed, and a lack of self-confidence in all areas of professional and social life. Conclusion: It is important to recognize that for some patients, excessive sweating can be a severely debilitating condition. Appropriate action must be taken in order to improve the patient's quality of life.
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