Randomized controlled study thoracoscopic sympathotomy and thoracoscopic sympathectomy for primary palmar hyperhidrosis

Abstract

Background One of the two halves of the autonomic nervous system, which controls the body’s unconscious reactions to maintain proper function, is the sympathetic nervous system. The body’s reaction to stress is controlled by the sympathetic nervous system (‘fight or flight‘ response). Aim The aim of this study was to evaluate feasibility, merits and demerits of thoracoscopic sympathotomy in comparison to thoracoscopic sympathectomy while in the management of primary palmar hyperhidrosis to assess recurrence, operative time, safety and associated complications. Subject and methods This prospective randomised study was carried out on fifty patients diagnosed to have primary palmar hyperhidrosis, twenty five (25) patients was treated by using two ports thoracoscopic sympathotomy while the patient was in supine position and twenty five (25) patients by using three ports thoracoscopic sympathectomy while the patient was in lateral position. This study was carried out at the surgical department of Beni-Suef University hospital and Military hospitals from January 2021 with a follow up period for six months. Results None of the patients developed recurrence Hemothorax, pneumothorax or intra-operative bleeding. Only one patient (4%) developed compensatory hyperhidrosis at each group. Also, only one patient (4%) developed post-operative Horner’s syndrome at each group. On the other hand, the percentage of patients developing dyspnea differed between the two groups as 12% (n=3) of patients in group B developed dyspnea which was higher than that of group A 4% (n=1). This difference was statistically insignificant as a Fisher’s exact test was conducted between group A and group B for developing dyspnea. There was a statistically insignificant association between type of intervention and dyspnea. Conclusion A therapy for treating PH that improves the severity of sweating and patient satisfaction is thoracoscopic sympathotomy. Numerous advantages of this minimally invasive procedure include decreased postoperative discomfort, a shorter hospital stay, quicker healing and return to work, and fewer problems.It is possible to treat both sides at once to eliminate the need for a second treatment and readmission. In addition, it takes less time to perform and has less consequences than three ports thoracoscopic sympathectomy for treating primary palmar hyperhidrosis with a similar success rate.