A systematic review and meta-analysis of T2, T3 or T4, to evaluate the best denervation level for palmar hyperhidrosis

Wenxiong Zhang,Yiping Wei,Xiaoqiang Zhang,Dongliang Yu,Jianjun Xu

doi:10.1038/s41598-017-00169-w

Wenxiong Zhang, Yiping Wei + Show 3 more

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https://doi.org/10.1038/s41598-017-00169-w

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Abstract

We systematically reviewed and compared the clinical outcomes of thoracoscopic sympathectomy (TS) at different denervation levels for palmar hyperhidrosis. We searched PubMed, Ovid MEDLINE, EMBASE, Web of Science, ScienceDirect, the Cochrane Library, Scopus and Google Scholar for relevant studies published during 1990–2016. Symptom resolution, patient satisfaction, compensatory sweating (CS), recurrence, dry hands and gustatory sweating were assessed. We selected 13 studies from 2228 for the final analysis. A comparison of T2 vs. T3 TS revealed that T3 TS reduced the risk of CS (95% confidence interval [CI]: 1.36–3.19, p = 0.0007) and moderate-to-severe CS (95% CI: 2.14–7.87, p < 0.0001). No significant differences were found in patient satisfaction, symptom resolution, and incidence of dry hands and gustatory sweating. A comparison of T3 vs. T4 TS revealed that T4 TS reduced the risk of CS (95% CI: 2.87–9.53, p < 0.00001), moderate-to-severe CS (95% CI: 2.54–5.83, p < 0.00001), dry hands (95% CI: 4.07–18.13, p < 0.00001) and gustatory sweating (95% CI: 1.53–7.32, p < 0.003), and improved patient satisfaction. No significant differences were found in symptom resolution and recurrence. T4 TS appears to be more useful than T3 or T2 TS for PH.

Highlights

We systematically reviewed and compared the clinical outcomes of thoracoscopic sympathectomy (TS) at different denervation levels for palmar hyperhidrosis
Conventional surgery to transect the sympathetic chain at the T2–T3 or T2–T4 levels can improve the symptom of Palmar hyperhidrosis (PH) perfectly well
TS at the T4 level has been recommended for the treatment of PH under the Lin-Telaranta classification, the optimal level for TS has been the subject of intense debate among thoracic surgeons, possibly due to a lack of large-scale clinical research in this area[9]

Summary

Introduction

We systematically reviewed and compared the clinical outcomes of thoracoscopic sympathectomy (TS) at different denervation levels for palmar hyperhidrosis. No significant differences were found in patient satisfaction, symptom resolution, and incidence of dry hands and gustatory sweating. A comparison of T3 vs T4 TS revealed that T4 TS reduced the risk of CS (95% CI: 2.87–9.53, p < 0.00001), moderate-to-severe CS (95% CI: 2.54–5.83, p < 0.00001), dry hands (95% CI: 4.07–18.13, p < 0.00001) and gustatory sweating (95% CI: 1.53–7.32, p < 0.003), and improved patient satisfaction. Conventional surgery to transect the sympathetic chain at the T2–T3 or T2–T4 levels can improve the symptom of PH perfectly well This type of surgery is associated with high incidence rates of complications such as compensatory sweating (CS) and dry hands[3,4,5]. In an attempt to resolve this issue and optimize surgical procedures, we performed a systematic review and meta-analysis of clinical trials investigating

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