Evaluation of patients who underwent bilateral uniportal video assisted thoracic sympathicotomy for primary hyperhidrosis

Abstract

Introduction: Primary hyperhidrosis (PH) is defined as localized excessive sweating, such as the palmar, plantar or axillar area. Video-assisted thoracic sympathicotomy (VTS) is successfully used worldwide in the invasive treatment of PH. Thoracoscopic sympathicotomy is a safe and simple procedure compared to other thoracic surgeries. Methods: We retrospectively evaluated a total of 130 consecutive PH patients who were treated via VTS in our department between June 2008 and June 2018.Fifty seven (77%) patients were male, 73 (23%) patients were female with a mean age of 26,01 ± 7,4 (18–38 years) years. Age, gender, indication and complication of VTS, surgical procedure, applied treatments, surgical outcomes were reviewed. Results: The operation indications were palmar and axillary hyperhidrosis in 62 (47,7%) patients, palmary hyperhidrosis in 48 (37%), axillary hyperhidrosis in 14 (10,8%) patients, flushing in 6 (4,6%) patients and Reynauld syndrome in 2 (1,6%) patients. Bilateral VTS was performed at T2 for flushing, T2-T3 for palmar-only hyperhidrosis, T2-T4 for palmar and axillary hyperhidrosis, and T3-T4 for axillary-only hyperhidrosis. In one patient additionnaly transaxillary first rib resection was performed for the thoracic outlet syndrome in same time. One hundred fifteen patients (88,5%) were satisfied, whereas only 15 (11,5%) were dissatisfied with the procedure. The mean operation time, chest tube removal time, length of hospital stay time was 32,24 ± 3.41 (20–50) minutes, 1,1 ± 0,3 (1-3) days, 1,6 ± 0,6 (2-5) days, respectively. The most common complication was compensatory hyperhidrosis (CH) (n:78, 59,6%) which was seen in the waist, the umbilicus, and the back during the mean follow-up period of 38,2 ± 9,2 (range 6-60) months. Recurrence was seen in nine (7%) patients in 6,2 ±2,4 months after the operation. There was no statistically significant difference in compensatory hyperhidrosis and recurrence development status with VTS performed ganglion levels (p> 0.05) Conclusion: Considering possible complication of CH cauterization technique with uniportal VTS can be successfully and safely performed in the treatment of primary hyperhidrosis.