Thoracic Sympathectomy For Hyperhidrosis Research Articles

Thoracic sympathectomy for hyperhidrosis with and without botulinum toxin injection

Background and aims Primary hyperhidrosis is a disorder of excessive sweating of unknown etiology, associated with emotional, psychological, and educational problems. This study described our experience in managing hyperhidrosis via endoscopic thoracic sympathectomy (ETS) with and without intradermal botulinum toxin type A (BTX-A) injections. Patients and methods This retrospective study included 50 patients treated by ETS with either BTX-A (20 patients) or not (ETS only; 30 patients) in security forces hospital, Saudi Arabia, between January 2014 and February 2017. Information was obtained from computerized medical records and a telephone survey about postoperative complications. Results A total of 50 patients were operated and included in this study. The mean age was 23.55±6.12 years. The majority (70%) had axillary and palmar hyperhidrosis and 30% had palmar hyperhidrosis. In ETS, surgical technique was done at T2–T3 level in 56% of patients. Mean ETS procedure time was 39.6±14.29 min, with no conversion. Mean hospital stay was 1.5±0.85 days. Success rates of ETS in patients with axillary and palmar were 95 and 96.7%, respectively, whereas success rates of BTX-A+ETS in patients with axillary and palmar were 100 and 100%, respectively. Compensatory sweating was recorded in 20% among every group, with minimal other postoperative and postinjection complications being recorded, with no significant difference between studied groups (P=0.316). Conclusion BTX-A injection followed by ETS is safer and effective and has minimal postoperative complications.

Thoracic sympathectomy for hyperhidrosis: from surgical indications to clinical results.

Sympathectomy and its variations have been performed in thoracic surgery for more than 100 years. However, its indications have undergone profound modifications in this period. Likewise, since then the surgical technique has also evolved dramatically up to the minimally invasive techniques worldwide accessible in present days. Currently, primary hyperhidrosis is, by far, the main indication for thoracic sympathectomy and this procedure is usually carried out thoracoscopically with excellent results. However, until today, hyperhidrosis is a part of thoracic surgery still surrounded by controversy, persisting as an open field over which some confusion still resides regarding its pathophysiology, terms definitions and operative approaches. The aim of this article is to provide a wide but easily comprehensible review of the theme, discussing and clarifying the major concepts with respect to its clinical presentation, all the presently available treatment options and strategies with their potential benefits and risks, the adequate patient selection for sympathectomy, as well as the postoperative clinical results.

Late results of endoscopic thoracic sympathectomy for hyperhidrosis and facial blushing (Br J Surg 2011; 98: 1719–1724)

Late results of endoscopic thoracic sympathectomy for hyperhidrosis and facial blushing (<i>Br J Surg</i> 2011; 98: 1719–1724)

Seasonal influence of the surgical outcome after thoracic sympathectomy for hyperhidrosis

Analyze the seasonal variation of the surgical results after sympathectomy through the seasons of the year. The surgical results are better in the spring, and the sudomotor reflex is worst in summer. Comparison of surgical results of distinct techniques should be done under the same climatic conditions.

Factors affecting long-term satisfaction after thoracic sympathectomy for palmar and plantar hyperhidrosis. Is the sudomotor reflex the only villain?

The main objective of this study was to determine if there are variations in the level of improvement of the palmar and plantar hyperhidrotic symptoms, as well as the incidence and intensity of the sudomotor reflex, throughout the seasons of the year, after thoracic sympathectomy for hyperhidrosis. The study also looks for the real impact of these variables in the long-term satisfaction. A cohort of 75 patients was followed through distinct seasons. A multivariate analysis was performed to identify possible variables responsible for dissatisfaction. Both the palmar (P=0.002) and plantar (P<0.001) symptoms and the presence and the intensity of the sudomotor reflex varies significantly throughout the seasons of the year. The sudomotor reflex was the main factor associated with low satisfaction in our patients in the summer (P=0.025) and winter (P<0.001) but in spring the lack of improvement in the hyperhidrosis in the foot was the unique factor related to dissatisfaction (P<0.001). The sudomotor reflex is the main negative factor in the summer and in the winter, independent of its intensity. However, at least in spring, the lack of removal of the plantar symptoms had a negative impact on satisfaction.

Acute Postoperative Shingles After Thoracic Sympathectomy for Hyperhidrosis

Shingles secondary to reactivation of a previous varicella-zoster virus infection has been reported to develop within surgical wounds and after trauma. We report the case of a 17-year-old girl with history of chicken pox in childhood who had acute postoperative shingles develop along the T3-T4 dermatomes after thoracic sympathectomy for hyperhidrosis. The possible causes and precipitating factors are discussed.