Transthoracic endoscopic sympathectomy for upper limb hyperhidrosis
Keywords:Axilla, Hyperhidrosis, Thoracosopy, Sympathectomy
Background: Hyperhidrosis is a disabling troublesome characterized by excessive perspiration that produces a social and professional deficit for patients. Thorasoscopic sympathectomy represents the best approach for this disorder. There are several methods for treatment of extensive hyperhydrosis which includes: Antiperispirant, anticholenergic, ionophoresis, psychotherapy, botulinum toxins injection and surgery. Endoscopic Thorasoscopic Sympathectomy (ETS) which is most safety, which require excision and electrocoagulation by cautery or ultrasonic shear which is used in this study, and by Clips application on the thoracic sympathetic ganglia between T2 to T4 or T5. ETS is minimally invasive procedure that increased the interest in this modality of treatment.
Methods: This prospective study include 78 cases admitted to IBN Sina Hospital, Sana’a, Yemen during the period of November 2013 and August 2017, 66 were male (84.6%) and, 12(15.4) are female. The procedure based on Endoscopic Thorasoscopic Sympathectomy.
Results: Seventy-eight patients underwent bilateral thorasoscopic, palmer hydrosis in 55 (70.5%) patients, 14 (17.9%) combined axillary, palmar and planter and 9 (11.6%) combined with planter and axillary hyperhidrosis. Complications included partial right pneumothorax requiring chest drain one case (1.28%), chronic wound pain five to seven months two cases (2.56%) and compensatory sweating twenty -three cases (29.5%). There was one (1.25%) exploratory rethoracoscopy for bleeding at the end of the procedure which was the third intercostal artery at the vertebra-costal junction and controlled by ultrasonic shear cauterization. No cases of Horner's syndrome were identified. There was no mortality.
Conclusions: Thorasoscopic sympathectomy is a safe and effective procedure for treatment of hyperhidrosis. Hospital stay is very short, lower post-operative rates of complication or infection and early wound healing. Patient more satisfied with the immediate treatment effects on the preoperative symptoms of hyperhidrosis.
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