Bilateral Sympathectomy Research Articles

Is Clipping Superior to Cauterization in the Treatment of Palmar Hyperhidrosis?

Endoscopic thoracic sympathectomy has been accepted as the most effective treatment for palmar hyperhidrosis (PH). However, there is a debate regarding the surgical techniques in terms of effectiveness, recurrence, and reversibility. In this study, sympathetic chain disruptions were compared in terms of whether the clipping or ablation technique had an effect on the long-term outcomes of patients who underwent thoracic sympathectomy for primary PH. All patients who underwent video-thoracoscopic sympathectomy for PH between May 2008 and October 2011 were included. Single-port bilateral sympathectomy was performed depending on the sweat distribution. As a standard approach, rib-based terminology was used to describe the blockade level of the sympathetic ganglia, and single-level R3 sympathectomy (between R3 and R4) was performed in all patients. The type of sympathectomy was changed. Monopolar electrocautery was first performed and 5-mm clips were then used for nerve disruption. Both techniques were evaluated and compared in terms of effectiveness, reversibility, and recurrence. Cauterization of the sympathetic chain was applied in 28 (47%) (Group A) patients and clipping in 32 (53%) patients (Group B). CH was the most common adverse effect and was observed in 43 (71.6%) patients (Group A, 71.4%; Group B, 71.8%; p = 0.8). The success rate was 93% for Group A and 100% for Group B (p = 0.15). The satisfaction rate for Group A was 83% and for Group B was 86% (p = 0.77). In Group A two patients (7%), and in Group B three patients (9%) requested reversibility because of severe compensatory hyperhidrosis. Overly dry hands were the other most common side effect and were identified in 12 (25%) patients. Recurrences were observed in 11 patients in Group A and 4 patients in Group B (19 vs. 6%; p = 0.01). The mean follow-up time was 33 ± 10.5 months (range, 13-53 months). Both clipping and cauterization are highly effective for the treatment of PH. The methods are comparable in terms of effectiveness and side effects despite the fact that the recurrence rate was higher in the cauterization group. Potential reversibility of compensatory sweating was not observed in our series. Identification of ideal candidates for surgery and education of patients about the permanent side effects of sympathectomy might make these techniques more convenient.

Endoscopic Thoracic Sympathectomy : A Comparative Study of Resection and Electro-Diathermy Ablation in the Treatment of Primary Palmar Hyperhidrosis : Taif Experience

Background and aim of the work: Palmar Hyperhidrosis is an excessive and unpleasant sweating and it is under control of the thoracic sympathetic chain. At present, endoscopic upper thoracic Sympathectomy (ETS) offers a safe and durable solution of the condition. The operation includes excision, electro diathermy ablation or application of surgical clips on the thoracic sympathetic ganglia T2 and T3. The present study was done to compare the results achieved by excision and electro-diathermy ablation. Patients and methods: This prospective randomized study was conducted in King Abdul Aziz Specialist Hospital and Al-Hada Armed Forces Hospital, Taif- Saudi Arabia, from January 2007 to August 2010 and included sixteen patients with primary palmar hyperhidrosis. They were randomized into 2 groups; each of 8 patients. In one group; the sympathetic chains with T2 and T3 ganglia were excised on both sides and in the other group, the sympathetic chains and ganglia were ablated bilaterally using electro-coagulation diathermy hook. Results: There were 10 women and six men. The mean age of the ablation group was 23.6±7.6 years and in the resection group it was 22.5±8.4years. The mean operating time for bilateral Sympathectomy in the resection group was 74±18.6minutes; whilst in the thermal ablation group it was 32±7.8 minutes. The mean postoperative hospital stay in the excision group was 48±12 hours and in the ablation group, it was24±6 hours. No deaths occurred and all patients are discharged with dry hands. The mean follow up was 24±18 months. Intraoperative intercostal venous bleeding occurred in 18.75% of sympathectomies in the excision group but not in the ablation group. Neuralgic pain of the chest wall developed in 31.25% of sympathectomies of the excision group and 6.25% of the sympathectomies of the ablation group. Horner's syndrome developed in 6.25% per cent of the sympathectomies in both groups. Compensatory hyperhidrosis of trunk and thighs occurred in 37.5% of both groups. Recurrence developed in 6.25% of ablation group but no recurrence in the excision group. Conclusion: The rate of recurrence after endoscopic thoracic sympathectomy for treatment of primary palmar hyperhydrosis, if ablation is used, may be higher than resection, however; it is practically accepted as the procedure is easier, has shorter operating time with less liability to develop neuralgic pain and intercostal venous bleeding.

Outcomes in Single Operation Bilateral Video-Assisted Thoracoscopic Sympathectomy Over a 10-year Period

ity of incidents occurring in the operating theatre, the ICU and ward. Results: There were a total of 639 reported incidents using the existing AIMS over a 10 year period prior to May 31st 2011 (48 operating theatre, 353 ICU, 238 ward), with an average frequency of 63.9 incidents per year. With the SLS there were a total of 281 incidents (21 operating theatre, 163 ICU, 97 ward), with an average frequency of 224.8 per year. After excluding inappropriate reports, there were 203 incidents (19 operating theatre, 105 ICU, 79 ward). The overall incidence of these reports per patient admission was 5.75% (203/3532 patient admissions: 1084 operating theatre, 1484 ICU, 964 ward), with the highest frequency occurring in the ward (8.20%) and the ICU (7.08%) when compared to the operating theatre (1.75%) (p< 0.0001). The majority of incidents in the ICU and ward were medication-related (35.24% and 40.51%, p= 0.54) and device/equipment-related incidents were significantly greater in the operating theatre (42.11%) when compared with the ICU (8.57%, p= 0.0007) and ward (10.13%, p= 0.002). Other types of incidents included patient behaviour, access, falls, communication/teamwork, implementation of care, staffing, patient information and treatment/procedure. There were no SAC1 incidents reported.Moderate-to-high risk incidents (SAC 2 or 3) occurred less frequently in the ward (15.19%) when compared with the ICU (60.95%, p< 0.0001) and the operating theatre (42.11%, p= 0.022). Discussion: The SLS is an effective way of gauging clinical risk in a cardiothoracic unit, and leads to more widespread reporting. As expected most reports from the ward and ICU were medication-related, while device/equipment reports predominated in the operating theatre. Reports from the ward tended to be of a lower risk. SAC 2 reports mandated a review by the hospital’s Safety and Quality Unit. SAC 3 and 4 reports were dealt with by the relevant location’s chief in charge and in some instances led to policy and protocol change.

Back To Blockers?

Back To Blockers?

Síndrome de Horner irreversible tras simpatectomía toracoscópica bilateral

Case reportA 19 year-old boy who developed a right Horner's syndrome after a bilateral sympathectomy as a treatment for palmoplantar hyperhidrosis. DiscussionHorner's syndrome is defined by the occurrence of miosis, ptosis and enophthalmos as a result of involvement of sympathetic innervation. This is quite rare, but identification is very important because it may also be an ominous sign secondary to a neoplasm, neurological diseases, or surgery of the sympathetic chain, as in our case.

Robotic Selective Postganglionic Thoracic Sympathectomy for the Treatment of Hyperhidrosis

The surgical management of hyperhidrosis is controversial. Robotic surgical systems with their high-definition magnified 3-dimensional view and increased maneuverability in a confined space may facilitate the technique of selective sympathectomy (ramicotomy). We present a case series of patients undergoing selective postganglionic thoracic sympathectomy using robotic technology. This study is a case series analysis of patients who underwent selective postganglionic thoracic sympathectomy from July 2006 to November 2011. The operation was performed on a video-assisted thoracoscopic surgery (VATS) platform. The robot was used for pleural dissection and division of the postganglionic sympathetic fibers and the communicating rami. The success of sympathectomy was assessed by intraoperative temperature measurement of the ipsilateral upper extremity, patient interviews, and scoring of the symptomatic nature of hyperhidrosis based on the Hyperhidrosis Disease Severity Scale. There were 110 sympathectomies performed in 55 patients (25 men, 30 women). Simultaneous bilateral sympathectomy was performed in all patients. Median age was 28 years (range, 16 to 65 years). There was no conversion to thoracotomy. Complications were minor and were seen in 5 of 55 patients (9%). There were no deaths. Median hospital stay was 1 day (range, 1 to 4 days). Of the 55 patients, 53 (96%) had sustained relief of their hyperhidrosis at a median follow-up of 24 months (range, 3 to 36 months), and compensatory sweating was seen in 4 patients (7.2%). Robotic thoracoscopic selective sympathectomy is an effective, feasible, and safe procedure with excellent relief of hyperhidrosis and low rates of compensatory sweating and complications.

Bilateral single‐port video‐assisted thoracic surgery sympathectomy for palmar hyperhidrosis with VasoView® device

Palmar hyperhidrosis, characterized by excessive sweating of the palms of the hands, can be a debilitating illness affecting patients’ social and psychological well-being. Primary hyperhidrosis usually starts during adolescence, with possible inheritance as an autosomal dominant genetic trait. Secondary causes, including thyroid or pituitary gland diseases, diabetes, malignancy, menopause, drug related or mercury poisoning, should be excluded. For primary palmar hyperhidrosis, first line treatments can include aluminium chloride antiperspirants, botulinum toxin injections, anticholinergic drugs (oxybutynin), and iontophoresis; however, the results are often suboptimal and short-term. Video-assisted thoracic surgery (VATS) sympathectomy is the definitive therapy with high success rates and low recurrence. Classically, a three-port bilateral VATS approach is utilized for this procedure. We report our novel technique on single-port VATS sympathectomy with the VasoView® Hemopro device.

Bilateral sympathectomy via thoracoscope for treatment of idiopathic hyperhidrosis

Objective To summarize our experience in endoscopic thoracic sympathectomy (ETS) in treating palmar hyperhidrosis (PH) and investigate the feasibility of ETS for treating PH by hand surgeons.Methods From 2006 to 2010,23 patients who had palmar hyperhidrosis were treated by a single surgeon via endoscopic thoracic sympathectomy.The T2 to T3 thoracic sympathetic chain was interrupted by electrocautery.The patients were followed up once every three months.Treatment that resulted in palm skin temperature increase of 1℃ or more and dry and warm palm skin was considered effective.Treatment that resulted in palm skin temperature increase less then 1℃ and wet palm skin was considered ineffective.Results All patients had immediate cessation of palmar hyperhidrosis.Mild compensatory hyperhidrosis on the back or sole was noted in 4 patients.No moderate to severe compensatory hyperhidrosis or other complications were observed.Postoperative follow-up ranged from 3 moths to 3 years,with an average of 18 months.There was no recurrence.The effective rate was 100％.Conclusion Endoscopic thoracic sympathectomy is a safe and effective way to treat palmar hyperhidrosis and is a procedure that can be mastered by hand surgeons without a steep leaming curve. Key words: Thoracoscopes; Hyperhidrosis; Sympathectomy; Compensatory hyperhidrosis

Laparoendoscopic Single-Site Retroperitoneal Lumbar Sympathectomy: Initial Report

Retroperitoneoscopic lumbar sympathectomy is a safe and effective treatment for plantar hyperhidrosis. To evaluate the safety and feasibility of laparoendoscopic single-site retroperitoneal lumbar sympathectomy in plantar hyperhidrosis. Bilateral laparoendoscopic single-site retroperitoneal lumbar sympathectomy was performed in a 27-year-old man who suffered from excessive sweating from the soles of the feet. A homemade single port was created with an Alexis wound retractor through a 2.5-cm incision at the tip of the 12th rib. With conventional 5-mm laparoscopy and instruments, retroperitoneal lumbar sympathectomy was performed. The procedure was completed successfully without any complications and with minimal blood loss. The operative time was 110 and 80 minutes for the procedure on the left and right sides. The perioperative course and postoperative course were uneventful. The patient had anhidrosis of both feet after surgery with Hyperhidrosis Disease Severity Scale score of 1 at the 1-month follow-up. Laparoendoscopic single-site retroperitoneal lumbar sympathectomy is a safe and feasible procedure according to our initial experience.

Effect of pre-existing inflammation on carrageenan-induced paw oedema in rats.

Twenty-four hours after injection of carrageenan into one hind paw, injection of the same amount into the contralateral paw produced a significantly attenuated inflammatory response. However, when the second injection was given 7 days later, the inflammation induced in the contralateral paw was comparable with the initial response to carrageenan. A time-course study of carrageenan-induced inflammation in rats showed that significant oedema persisted 24 h after carrageenan administration and complete recovery was achieved in 7 days. The attenuated inflammatory response in the contralateral paw after 24 h was antagonized by bilateral adrenalectomy and chemical sympathectomy induced by 6-hydroxydopamine. Carrageenan-induced paw oedema was also significantly less in rats with subacute inflammation induced by the croton oil granuloma pouch technique. This attenuated response was antagonized by pretreatment of the rats with metyrapone, an inhibitor of adrenocorticoid synthesis, and by 6-hydroxydopamine. It is likely that the pre-existing acute or subacute inflammation attenuates the inflammatory response of carrageenan, by acting as a stressor, inducing activation of the sympatho-adrenal system.

Bilateral retroperitoneoscopic lumbar sympathectomy by unilateral access

Purpose: Hyperhidrosis is a condition characterized by hyperactivity of the eccrine glands, causing an uncontrollable and excessive sweating, especially on the hands, plantar foot and groin, which can be confused with urinary incontinence. Standard treatment for plantar hyperhidrosis is the laparoscopic lumbar sympathectomy and the urologists are the besttrained surgeons to perform this procedure because they are familiar with the retroperitoneal anatomy. The goal of this video is to show our own technique of bilateral lumbar sympathectomy by unilateral access for plantar hyperhidrosis. Methods: The sample consisted of ten female patients who presented with plantar hyperhidrosis and were submitted to bilateral retroperitoneoscopic lumbar sympathectomy by unilateral access technique. All patients had already been submitted to a previous thoracic sympathectomy with no improvement of the plantar hyperhidrosis. Results: Ten procedures were performed with this technique. In only one case, the bilateral retroperitoneal approach was required because of difficulty in locating the right nerve. Mean operative time and mean estimated blood loss were 68 minutes and 54 cc, respectively. We had no intraoperative complications and patients were discharged home 19.6 hours after surgery. Immediate warming of the feet was observed at the end of all procedures. On follow-up consultations, all patients referred complete resolution of the plantar hyperhidrosis. Only one patient developed compensatory hyperhidrosis in her back. Conclusions: Retroperitoneoscopic lumbar sympathectomy by unilateral access seems to be feasible when performed by a surgeon with experience on advanced laparoscopy. Larger series comparing unilateral to bilateral access are necessary to establish the real benefits and potential disadvantages of this new technique.

Bilateral single-port thoracoscopic sympathectomy with the VasoView® device in the treatment of palmar and axillary hyperhidrosis☆

Primary or essential hyperhidrosis is a disorder characterized by excessive sweating beyond physiological needs. It is a common disease (with an incidence of up to 2.8%) that causes intense discomfort for patients. Video-assisted thoracoscopic bilateral sympathectomy is an effective surgical treatment with high success rates and improvement in quality of life. In the last decade, the advantages of a single-port thoracoscopic approach have become clear. Problems with intraoperative bleeding management have been solved by using thoracoscopes with integrated electrocautery scissors. In this report, we describe successful transaxillary bilateral single-port thoracoscopic T2-T5 sympathectomy with the VasoView® device in three patients with palmar and axillary hyperhidrosis. The VasoView® device, with its integrated electrocautery scissors, was originally designed for endoscopic vessel harvesting in coronary artery bypass surgery, but it has proven highly effective for single-port thoracoscopic sympathectomy.

Endoscopic Thoracic Sympathectomy: Long-Term Results for Treatment of Upper Limb Hyperhidrosis and Facial Blushing

Background : Endoscopic thoracic sympthectomy (ETS) is frequently used in the management of patients with hyperhidrosis and excessive blushing. Long term-follow up is scarce. We retrospectively reviewed long-term morbidity, success and overall patient satisfaction rates in patients operated in our department.Method : Data of all patients undergoing ETS for either upper limb hyperhidrosis or facial blushing and sweating between January 1994 and December 2006 were reviewed. A standard questionnaire inquiring on relief of symptoms, satisfaction with the operation and occurrence of compensatory sweating (CS) was sent out in January 2008. Results : We performed bilateral thoracoscopic sympathectomies in 73 patients. There were no operative mortalities, minor complications occurred in 22%. Initial success rate was 88%. Median follow up was 93 (24–168) months, response rate to the questionnaire was 85%. Sixty-nine per cent of patients continued to have relief of initial symptoms, whereas patient satisfaction rate was 56%. CS was present in 42 patients (68%). Long-term satisfaction rates per initial indication group were 42% for facial blushing and 65% for hyperhidrosis (n.s.), and CS was present in 79% vs 61%, respectively. Conclusion : ETS appears a safe treatment for upper limb hyperhydrosis with acceptable long-term results. For excessive blushing, however, long term satifaction rates of ETS are severely hampered by a high incidence of disturbing compensatory sweating. ETS should only be indicated in patients with unbearable symptoms refractory to non-surgical treatment. The patient information must include the long-term substantial risk for sever CS and regret of the procedure.

The choice of thoracoscopic sympathectomy in the treatment of palmar hyperhidrosis among different procedures

Retrospective analyze the long-term efficacy and compensatory sweating of thoracoscopic sympathectomy in the treatment of palmar hyperhidrosis by different operative methods in order to search after a better operative method. Retrospective study of 643 cases (498 cases available) palmar hyperhidrosis who accepted video-assisted thoracoscopic bilateral sympathectomy during from 1995 to Aug 2008. The patients were divided into four groups by different operative methods. (1) Group A(n = 82): Thoracoscopic T2-4 sympathectomy was performed. (2) Group B (n = 135): Thoracoscopic T2 sympathectomy was performed. (3) Group C (n = 41): Thoracoscopic T2 sympathetic nerve clipped. (4) Group D (n = 240): Thoracoscopic T3-4 level sympathectomy plus bypass fiber (Kuntz fiber) resection on same level was performed. All procedures were successfully performed under thoracoscope without severe morbidity and mortality. The curative rate of palmar hyperhidrosis was 100.00%. The incidence of compensatory sweating were 54.9% (group A), 48.1% (group B), 48.8% (group C) and 28.8% (group D) respectively with significantly decrease in group D contrast to other three groups. The incidence of high-grade compensatory sweating which have important influences on daily life were 9.8% (group A), 10.4% (group B), 9.8% (group C) and 2.9% (group D) respectively with significantly decrease in group D. Other pairings have nonsignificance. The relapse rate were 1.2% (group A), 2.2% (group B), 7.3% (group C) and 0.8% (group D). Only when group D contrasted to group C has significantly decrease in the relapse rate (χ(2) = 8.423, P = 0.004). Other pairings have nonsignificance. The procedure of T3-4 sympathectomy plus bypass fiber resection is reasonable operative method to cure hyperhidrosis with the better curative effect and lowest incidence of compensatory hyperhidrosis.

Evidence for a Predominant Intrinsic Sympathetic Control of Cerebral Blood Flow Alterations in an Animal Model of Cerebral Arteriovenous Malformation

In terms of neurogenic cerebral blood flow (CBF) control, the activity of the sympathetic nervous system (SNS) has a regulating effect. The impact of a manipulation of both the peripheral (via the perivascular sympathetic net) and central components (via the intracortical noradrenergic terminals originating from the locus coeruleus) on CBF-and especially on hyperperfusion syndromes-is unclear. To test the specific patterns following such alterations, cortical oxygen saturation (rSO2), regional CBF (rCBF), and cortical interstitial norepinephrine (NE) concentrations were measured. Twelve weeks after either the creation of an extracranial AV fistula or sham operation, 80 male Sprague-Dawley rats underwent one of the following procedures: (1) no SNS manipulation, (2) peripheral SNS inhibition via bilateral sympathectomy, (3) central SNS inhibition via the neurotoxin DSP-4, or (4) complete SNS inhibition. Norepinephrine concentrations were lowest after complete inhibition (NE [nmol]: pre, 1.8 ± 1.2; post, 2.4 ± 1.8) and highest following peripheral inhibition (NE [nmol]: pre, 3.6 ± 1.9; post, 6.6 ± 4.4). Following fistula occlusion, rCBF (laser Doppler unit [LDU]) and rSO2 (%SO2) increases were highest after complete inhibition (pre: 204 ± 14LDU, 34 ± 3%SO2; post: 228 ± 18LDU, 39 ± 3%SO2) and lowest after peripheral inhibition (pre: 221 ± 18LDU, 41 ± 2%SO2; post: 226 ± 14LDU, 47 ± 2%SO2). Thus, a complete inhibition down-regulates SNS activity and provokes a cortical hyperperfusion condition. With this, the hitherto unknown predominant role of the intrinsic component could be demonstrated for the first time in vivo.

Sympathectomy suppresses tumor growth and alters gene‐expression profiles in rat tongue cancer

Sympathetic nerves are known to affect carcinogenesis. Recently we found that sympathetic denervation decreases the size of rat tongue tumors. To identify genes involved in rat tongue carcinogenesis and to study the effect of sympathetic nerves on these genes, we compared gene-expression profiles in normal rat tongue (control) and in tumor-induced tongues with (SCGx) and without (Sham) bilateral sympathectomy. Significance analysis of microarrays revealed 280 genes (168 up-regulated, 112 down-regulated) that showed at least a twofold differential expression between Sham and SCGx tumors (false discovery rate < 5%). These included genes associated with cell adhesion, signaling, structure, proliferation, metabolism, angiogenesis, development, and immunity. Hierarchical clustering demonstrated that controls and sympathectomized tumors grouped together, while Sham tumors grouped separately. We identified 34 genes, known to be involved in carcinogenesis, that were not differentially expressed between sympathectomized tumors and control tongues, but which showed a significant change in expression in Sham tumors. Microarray results of 12 of these genes were confirmed by quantitative reverse transcription-polymerase chain reaction. In conclusion, sympathectomy significantly altered the gene-expression profile and inhibited tumor growth. The expression of several cancer genes were increased more than threefold in Sham tumors, but unaltered in the sympathectomized tumors when compared with controls, indicating that these genes may be of significance in rat tongue carcinogenesis.

Midodrine for the treatment of organic anejaculation but not spinal cord injury: a prospective randomized placebo-controlled double-blind clinical study.

Anejaculation is a rare cause of infertility and adversely affects the general sense of well-being and perception of sexual life satisfaction. Evidence to support effective and noninvasive treatment for this ejaculatory disorder is lacking. This study aimed to evaluate the efficacy and safety of midodrine (alpha(1)-adrenergic receptor agonist) for the treatment of organic anejaculation but not spinal cord injury (SCI). A total of 128 patients were randomly assigned to oral midodrine 7.5-15 mg per day in a stepwise approach (group 1, n=64), or a similar regimen of placebo (group 2, n=64). They underwent a complete physical examination, echocardiography, 12-lead electrocardiogram, transrectal ultrasonography, complete blood count and blood chemistry. Hormonal assays included serum levels of luteinizing hormone, follicle-stimulating hormone, prolactin and testosterone. To rule out other sexual dysfunction, patients also completed the International Index of Erectile Function questionnaire. Psychiatric disorders were excluded by appropriate tests. Outcome measure was reversal of the anejaculation. None of the patients in the placebo group achieved antegrade or retrograde ejaculation. At the end of study, antegrade, retrograde and antegrade+retrograde ejaculation occurred in 18 (29.5%), 8 (13.1%) and 9 (14.8%) patients in midodrine group, respectively (all P=0.01). The most and least favorable responses were among patients with multiple sclerosis and bilateral sympathectomy, respectively. Midodrine improved ejaculation function in a dose-dependent manner. Four participants (6.3%) in midodrine group discontinued this study for reasons of adverse events. In patients with organic anejaculation but without SCI midodrine can reverse anejaculation in more than 50% of patients. Further studies are needed, however, for the evaluation of different treatment regimens in anejaculation therapy.

Successful treatment of catecholaminergic polymorphic ventricular tachycardia with bilateral thoracoscopic sympathectomy

Successful treatment of catecholaminergic polymorphic ventricular tachycardia with bilateral thoracoscopic sympathectomy

Painful digital infarction in a male smoker treated as Buerger's disease

A 40-year-old male smoker presented with a 3-week history of painful digital infarction involving the hands. Histology was unhelpful, showing lichen simplex chronicus. A provisional diagnosis of a vasculitic disease was made. Treatment included aspirin, azathioprine, iloprost, methylprednisolone, nifedipine and prednisolone. After failure of these treatments an alternative clinical diagnosis of Buerger's disease was made. Treatment was to advise the patient of the importance of continuing to abstain from smoking, to perform bilateral video-assisted thoracoscopic sympathectomies and to commence folate supplementation. This led to marked improvement of his symptoms and healing of the digital infarction.

Usefulness of Bilateral Sympathectomy Using Video-Assisted Thorascopic Surgery in the Treatment of Essential Hyperhidrosis

Essential, idiopathic, or primary hyperhidrosis is defined as excessive sweating in certain areas of the body due to factors unrelated to other disease. Clinical presentation can be categorized as palmar, plantar, axillary, or craniofacial. Medical treatment (aluminium salts, iontophoresis, anticholinergic drugs, and alfa-2-agonists) is of questionable effectiveness. Intradermal injections of botulinum toxin are very effective for the treatment of axillary hyperhidrosis. Surgical treatment involves resection (sympathectomy) or electrocautery (sympathicolysis) of the thoracic sympathetic chain, or compression of the sympathetic chain with clips, in all cases via video-assisted thorascopic surgery. One or more ganglia between T2 and T5 are usually resected depending on the area affected by hyperhidrosis: T2 for craniofacial hyperhidrosis, T3 and T4 for palmar hyperhidrosis, and T3 to T5 for combined palmar and axillary hyperhidrosis. The technique is very useful and is effective in those patients with primary hyperhidrosis who have not responded to conservative treatment.