Abstract
PurposesWe compared two different surgical methods evaluating the effectiveness of procedures and the quality of life (QoL) of patients.MethodsFrom January 2010 to November 2017 we carried out 476 biportal video-assisted thoracoscopic surgery (VATS) approaches of sympathetic chain in 238 patients. One hundred and twenty-nine (54%) patients underwent conventional sympathectomy (CS) while 109 (46%) patients underwent sympathicotomy associated with the division of the rami communicantes (MWT). Quality of Life (QoL) was classified as follows: from 20 to 35 excellent; from 36 to 51 very good; from 52 to 68 good; from 69 to 84 poor; and > 84 very poor.ResultsWe noticed statistical significant reduction of complications comparing CS with MWT approaches (chest pain from 36.4 to 4.5%; paresthesias from 8.5 to 3.6%; bradycardia from 28.6 to 10%, respectively). The preoperative and postoperative QoL index evaluation revealed a statistically significant improvement after surgery (CS: 86 ± 2 versus 35 ± 1, p = 0.00001; MWT: 85 ± 1 versus 33 ± 2, p = 0.00001), with general satisfaction of the two techniques.ConclusionModified Wittmoser method seems to be a valid alternative to conventional sympathectomy, minimizing the percentage rate of complications and showing significant effectiveness in the quality of life improvement.
Highlights
Primary hyperhidrosis (PHH) involves a series of pathophysiological mechanisms and characterized by an idiopathic, chronic, usually focal, bilateral and symmetrical sweating manifesting itself in all seasons and exacerbated by stress, anxiety, fear or nervousness, as a result of an autonomic dysreflexia [1, 2]
The aim of this study is to introduce a modification to the Wittmoser’s technique (MWT), evaluating its efficacy and safety by comparing it to conventional sympathectomy (CS)
We considered the Wittmoser technique (WT) which provides the exclusive section of rami communicantes [13] eligible for modification and completing it with the sympathetic trunk section (MWT)
Summary
Primary hyperhidrosis (PHH) involves a series of pathophysiological mechanisms and characterized by an idiopathic, chronic, usually focal, bilateral and symmetrical sweating manifesting itself in all seasons and exacerbated by stress, anxiety, fear or nervousness, as a result of an autonomic dysreflexia [1, 2]. Several techniques have been described with minimally invasive approaches such as single-port ones and promising outcomes both in morbidity and mortality, as required for a benign condition such as PHH. In this regard, Cerfolio et al [12] did not find any superiority in any of them, being a complete nerve disruption the only aspect to pursue in order to avoid regrowth and symptoms. We considered the Wittmoser technique (WT) which provides the exclusive section of rami communicantes [13] eligible for modification and completing it with the sympathetic trunk section (MWT). The rationale for our decision of modifying the WT was an attempt to verify if a reduction of complications (in particular compensatory hyperhidrosis) and recurrences would be obtained by sectioning both the sympathetic trunk and the rami communicantes
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