DOI: http://dx.doi.org/10.18203/2349-2902.isj20190464

Transthoracic endoscopic sympathectomy for upper limb hyperhidrosis

Mohamed Abdullah Alkatta, Wail Mohamed Alqatta

Abstract


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.


Keywords


Axilla, Hyperhidrosis, Thoracosopy, Sympathectomy

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References


Doolittle J, Walker P, Mills T, Thurston J. Hyperhidrosis: an update on prevalence and severity in the United States. Arch Dermatol Res. 2016;308(10):743-9.

Hughes J. Endothoracic Sympathectomy. J Royal Soc Med. 1942;35(9):585-6.

Strutton DR, Kowalski JW, PharmD, Glaser DA, Stang PE. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: Results from a national survey. J Am Acad Dermatol. 2004;51(2):241-8.

Bechara FG, Gambichler T, Bader A, Sand M, Altmeyer P, Hoffmann K. Assessment of quality of life in patients with primary axillary hyperhidrosis before and after suction-curettage. J Am Acad Dermatol. 2007;57(2):207-12.

Keaveny T V., Fitzgerald PAM, Donnelly C, Shanik GD. Surgical management of hyperhidrosis. Br J Surg. 1977;64(8):570-1.

Eisenach JH, Atkinson JLDD, Fealey RD. Hyperhidrosis: Evolving Therapies for a Well-Established Phenomenon. Elsevier Ltd; 2005:657-666.

Drott C, Göthberg G, Claes G. Endoscopic transthoracic sympathectomy: An efficient and safe method for the treatment of hyperhidrosis. J Am Acad Dermatol. 1995;33(1):78-81.

Atkinson JLD, Fode-Thomas NC, Fealey RD, Eisenach JH, Goerss SJ. Endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis: Outcomes and complications during a 10-year period. Mayo Clin Proceed. 2011;86(8):721-9.

Dumont P, Denoyer A, Robin P. Long-term results of thoracoscopic sympathectomy for hyperhidrosis. Ann Thoracic Surg. 2004;78(5):1801-7.

Herbst F, Plas EG, Függer R, Fritsch A. Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs: A critical analysis and long-term results of 480 operations. Ann Surg. 1994;220(1):86-90.

Gossot D, Galetta D, Pascal A, Debrosse D, Caliandro R, Girard P, et al. Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis. Ann Thoracic Surg. 2003 Apr 1;75(4):1075-9.

Neumayer C, Zacherl J, Holak G, Függer R, Jakesz R, Herbst F, et al. Limited endoscopic thoracic sympathetic block for hyperhidrosis of the upper limb: reduction of compensatory sweatng by clipping T4. Surg Endoscopy Interventional Tech. 2004 Jan 1;18(1):152-6.

Fibla JJ, Molins L, Manuel Mier J, Vidal G. Effectiveness of sympathetic block by clipping in the treatment of hyperhidrosis and facial blushing. Interactive Cardiovas Thoracic Surg. 2009;9(6):970-2.

Sugimura H, Spratt EH, Compeau CG, Kattail D, Shargall Y. Thoracoscopic sympathetic clipping for hyperhidrosis: Long-term results and reversibility. J Thoracic Cardiovasc Surg. 2009;137(6):1370-8.

Neumayer C, Panhofer P, Zacherl J, Bischof G. Effect of endoscopic thoracic sympathetic block on plantar hyperhidrosis. Arch Surg. 2005;140(7):676-80.

Adar R, Kurchin A, Zweig A, Mozes M. Palmar hyperhidrosis and its surgical treatment: a report of 100 cases. Ann Surg. 1977 Jul;186(1):34.

Doolabh N, Horswell S, Williams M, Huber L, Prince S, Meyer DM, et al. Thoracoscopic sympathectomy for hyperhidrosis: indications and results. Ann Thoracic Surg. 2004 Feb 1;77(2):410-4.

Hashmonai M, Assalia A, Kopelman D. Thoracoscopic sympathectomy for palmar hyperhidrosis. Surg Endoscopy. 2001;15(5):435-41.

Jeganathan R, Jordan S, Jones M, et al. Bilateral thoracoscopic sympathectomy: results and long-term follow-up. Interactive Cardiovasc Thoracic Surg. 2008;7(1):67-70.

Hsia J-YY, Chen C-YY, Hsu C-PP, Shai S-EE, Yang S-SS. Outpatient thoracoscopic limited sympathectomy for hyperhidrosis palmaris. Ann Thoracic Surg. 1999;67(1):258-259.

Fox AD, Hands L, Collin J. The results of thoracoscopic sympathetic trunk transection for palmar hyperhidrosis and sympathetic ganglionectomy for axillary hyperhidrosis. Eur J Vascular Endovasc Surg. 1999 Apr 1;17(4):343-6.

Hederman WP. Endoscopic sympathectomy. The Br J Surg. 1993;80(6):687-8.

Kwong KF, Cooper LB, Bennett LA, Burrows W, Gamliel Z, Krasna MJ. Clinical Experience in 397 Consecutive Thoracoscopic Sympathectomies. Ann Thoracic Surg. 2005;80(3):1063-6.

Cina C, Cina M, Clase C. Endoscopic thoracic sympathectomy for hyperhidrosis: Technique and results. J Minimal Access Surg. 2007;3(4):132.

Moya J, Ramos R, Morera R, Villalonga R, Perna V, Macia I, et al. Thoracic sympathicolysis for primary hyperhidrosis. Surg Endoscopy Interventional Tech. 2006 Apr 1;20(4):598-602.

Licht PB, Pilegaard HK. Severity of compensatory sweating after thoracoscopic sympathectomy. Ann Thoracic Surg. 2004;78(2):427-31.

Reisfeld R. One-year follow-up after thoracoscopic sympathectomy for hyperhidrosis. Ann Thoracic Surg. 2007;83(1):358-359.

Lesèche G, Castier Y, Thabut G, Petit MD, Combes M, Cerceau O, et al. Endoscopic transthoracic sympathectomy for upper limb hyperhidrosis: limited sympathectomy does not reduce postoperative compensatory sweating. J Vasc Surg. 2003 Jan 1;37(1):124-8.

Keller MS, Sekons D, Scher H, Homel P, Bookbinder M. A novel scale for assessing quality of life following bilateral endoscopic thoracic sympathectomy for palmer and plantar hyperhidrosis. In: 4th International Symposium on Sympathetic Surgery. 2001:1-22.

Primary focal hyperhidrosis. Available at: http://sinalib.ir/uptodate/contents/mobipreview.htm?1/14/1257/abstract/73. Accessed 19 May 2018.

Lai YT, Yang LH, Chio CC, Chen HH. Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy. Neurosurg. 1997;41(1):110-5.

Chiou, Chen, Chiou TSM, Chen SC. Intermediate-term results of endoscopic transaxillary T2 sympathectomy for primary palmar hyperhidrosis. Br J Surg. 1999;86(1):45-7.

Adar R. Compensatory hyperhidrosis after thoracic sympathectomy. Lancet. 1998 Jan 24;351(9098):231-2.