Severity of compensatory sweating after thoracoscopic sympathectomy

Background

Compensatory sweating is a well-known side effect after sympathectomy for hyperhidrosis. It is often claimed to correlate with the extent of sympathectomy, but results from the literature are conflicting, and few have actually considered differences in the intensity of compensatory sweating.

Methods

A total of 158 patients underwent thoracoscopic sympathectomy for primary hyperhidrosis or blushing, or both. Sympathectomy was performed bilaterally at Th2 for facial hyperhidrosis/blushing (n = 49), Th2-3 for palmar hyperhidrosis (n = 62), and Th2-4 for axillary hyperhidrosis (n = 47).

Results

Follow-up by questionnaire was possible in 94% of patients after a median of 26 months. Compensatory sweating occurred in 89% of patients and was so severe in 35% that they often had to change their clothes during the day. The frequency of compensatory sweating was not significantly different among the three groups, but severity was significantly higher after Th2-4 sympathectomy for axillary hyperhidrosis (p = 0.04). Gustatory sweating occurred in 38% of patients, and 16% of patients regretted the operation.

Conclusions

Compensatory and gustatory sweating were remarkably frequent side effects after thoracoscopic sympathectomy for primary hyperhidrosis. We found no significant difference between the level of sympathectomy and the occurence of compensatory sweating. However, it appears that this is the first study to demonstrate that severe sweating is significantly more frequent after Th2-4 sympathectomy for axillary hyperhidrosis. We encourage informing patients thoroughly about these side effects before surgery.     

Influence of T3 or T4 sympathicotomy for palmar hyperhidrosis

Background

This retrospective study aimed to compare the efficacy of video-assisted thoracoscopic sympathicotomy at the T3 or T4 level in the treatment of palmar hyperhidrosis.

Methods

Patients were operated on for palmar hyperhidrosis from April 2004 to December 2007, and classified as the T3 (n = 56) or T4 (n = 63) sympathicotomy group.

Results

The rate of dryness and compensatory hyperhidrosis (CH) was significantly lower in the T4 sympathicotomy group than the T3 group (P < .01). Satisfaction rate, recurrence, and improvement of plantar sweating were of no statistical significance in either group.

Conclusions

Although both sympathicotomies were effective, safe, and minimally invasive methods for the treatment of palmar hyperhidrosis, T4 appeared to be a more optimal technique with less CH.     

Compensatory sweating after thoracoscopic sympathectomy: an acceptable trade-off

Background/Purpose

Palmar hyperhidrosis is a fairly common condition that is treatable by thoracoscopic sympathectomy (TS). Compensatory sweating (CS) is a major side effect of TS. We surveyed post-TS patients to determine the procedure's long-term success, satisfaction, complications, the natural history of CS, and whether those with CS would still have undergone the procedure.

Methods

A chart review of all patients who had undergone TS at 2 medical centers yielded 621 patients (mean age, 16.1 years) with a follow-up of more than 24 months: 265 (43%) could be contacted and agreed to reply to a detailed telephone questionnaire.

Results

Most participants (97%) reported complete (89.4%) or reasonable (7.6%) symptomatic relief. The long-term postoperative satisfaction was high (84.5%). Forty-one percent of the participants claimed that their quality of life decreased moderately or severely as a result of CS. Only 19.6% would not have undergone the operation in retrospect; there was a significant interesting difference regarding this issue between adults (31.4%) and children (8.8%).The extent of the CS did not change with time in 70% of the patients. It exacerbated in 10% and it diminished in 20%, usually within the first 2 postoperative years.

Conclusions

Thoracoscopic sympathectomy relieves hyperhidrosis in most cases. Patients prefer relief from palmar hyperhidrosis even at the cost of a high rate of CS. Hyperhidrosis is not a self-limiting condition, and we recommend not postponing TS until adulthood.     

The results of thoracoscopic sympathetic trunk transection for palmar hyperhidrosis and sympathetic ganglionectomy for axillary hyperhidrosis.

OBJECTIVES: To review our total experience of thoracoscopic sympathetic trunk transection for the treatment of palmar hyperhidrosis and second and third thoracic sympathetic ganglionectomy for axillary hyperhidrosis. DESIGN: Longitudinal cohort study following up consecutive patients for 0.3 to 5.5 years. SUBJECTS: Fifty-four consecutive patients undergoing thoracoscopic sympathectomy for hyperhidrosis. METHODS: Prospective evaluation of immediate technical success, complications, late recurrence of hyperhidrosis and patient acceptability. RESULTS: 100% initial cure for palmar hyperhidrosis, 91% of sympathetic ganglionectomies for axillary hyperhidrosis were technically successful and initially curative. Compensatory sweating 44% patients, most severe after bilateral sympathetic ganglionectomy. Complications occurred in 14% patients, all resolving without further intervention. There were no cases of Horner's syndrome. 13% patients reported a return of some palmar sweating. 5.4% patients developed recurrent palmar hyperhidrosis at 6, 15 and 21 months postoperatively. CONCLUSION: Transection of the sympathetic trunk between the first and second thoracic sympathetic ganglia initially cures 100% of patients treated primarily for palmar hyperhidrosis. Technically successful 2nd and 3rd thoracic sympathetic ganglionectomy initially cures 100% of patients with axillary hyperhidrosis. Compensatory sweating is common after bilateral sympathectomy. Recurrent palmar hyperhidrosis occurs in 5.4% of cases, but can be cured by a second thoracoscopic sympathectomy. Horner's syndrome is an avoidable complication of thoracoscopic sympathectomy.     

腋下单孔交感链切断术治疗手汗症

目的探讨胸腔镜经腋下单孔T3、T4交感神经链切断术治疗手汗症的治疗效果和技术要点。方法2008年5月至2010年8月采用胸腔镜经腋下单孔T3、T4交感神经链切断术治疗手汗症患者36例,通过分析临床指标,评价该术式的有效性、安全性。结果均通过腋下单孔完成手术,无延长及增加切口者。术后单侧气胸1例,无Homer’s综合征及其他严重并发症。36例手汗症状均完全缓解,轻度代偿性多汗13例（36．1％）,中度2例（5．56％）,无重度代偿性多汗。结论胸腔镜经腋下单孔T3、T4交感链切断术治疗手汗症是一种安全、有效、微创的手术方式。     

Selective division of T3 rami communicantes (T3 ramicotomy) in the treatment of palmar hyperhidrosis

Background

Compensatory sweating (CS) is the main cause of a patient's dissatisfaction after sympathetic surgery for palmar hyperhidrosis. Preservation of the sympathetic nerve trunk and limitations on the range of dissection are necessary to reduce CS.

Methods

We compared 64 patients (31 male, 33 female) (group 1) who underwent a T2 sympathicotomy between July 1998 and February 1999 and 83 patients (58 male, 25 female) (group 2) who underwent a T3 ramicotomy between August 2000 and December 2002.

Results

In group 1, 60 patients (93.8%) exhibited a decreased sweating on both hands, but 4 patients (6.2%) exhibited a persistent sweating on both hands. For group 2, 58 patients (69.9%) experienced a decreased sweating on both hands, 15 patients (18.1%) experienced a persistent sweating on both hands, and 10 patients (12.0%) experienced a persistent sweating on one hand. The grade of CS in group 2 was significantly lower than in group 1 (p < 0.001) and, notably, the rate of embarrassing and disabling CS in group 2 (15.5% [9 out of 58]) was significantly lower than in group 1 (43.3% [26 out of 60], p value < 0.001). The rate of satisfaction was 78.1% (50 out of 64) for group 1 and 68.6% (57 out of 83) for group 2 with no significant statistical difference indicated (p = 0.202).

Conclusions

The incidence of sweating postoperatively was relatively high in the T3 ramicotomy group, although the T3 surgery did result in a lower incidence of CS when compared with a T2 sympathicotomy.     

Bilateral thoracoscopic sympathectomy: results and long-term follow-up

The aim of this study is to evaluate the efficacy of bilateral thoracoscopic sympathectomy in alleviating symptoms and improving quality of life in patients with hyperhidrosis or facial blushing and to investigate the occurrence, severity and possible underlying factors to compensatory sweating after surgery. One hundred and sixty-three patients in a single institution underwent bilateral thoracoscopic sympathectomy with a mean follow-up period of 51 (5-140) months. Indications were for palmar hyperhidrosis (41%), axillary hyperhidrosis (17%), combined palmar and axillary hyperhidrosis (27%) and facial blushing+/-facial hyperhidrosis (15%). Success rates were palmar 98.5%, axillary 96.4%, palmar and axillary 97.7% and facial blushing+/-facial hyperhidrosis 84%. Compensatory sweating occurred in 77% of patients and its severity was related to the severity of the primary complaint. Recurrence rates were palmar 4.6%, axillary 7.4%, palmar and axillary 9.3% and facial blushing+/-facial hyperhidrosis 4.7% at a mean of 22 (3-72) months. An improvement in quality of life was seen in 85% and a diminution of quality of life was noted in 5% due to compensatory sweating. This large mature series demonstrates that bilateral thoracoscopic division of the sympathetic chain as opposed to resection can be performed effectively in patients with success rates higher than 90% and low recurrence rates.     

Therapie der palmaren und axillären Hyperhidrose

Background

Thoracic sympathectomy is a valuable treatment option for patients with primary hyperhidrosis. However, controversies exist about the optimal technique of sympathectomy and the association between localisation of the focal hyperhidrosis and postoperative results.

Patients and methods

Retrospective analysis was performed on prospectively collected data of 402 thoracic sympathectomies performed in 204 consecutive patients with palmar-plantar (n=123), palmar-axillary (34), isolated axillary (35), and craniofacial (12) hyperhidrosis. The standard procedure was video-assisted thoracoscopic resection of the sympathetic chain from T2 to T4/5.

Results

All procedures were performed thoracoscopically without serious perioperative complications. Postoperative morbidity was 2.5% (10/402) including two cases of incomplete Horner’s syndrome (0.5%). One hundred forty-three patients were followed for a mean of 21 months (6–86). Palmar hyperhidrosis was eliminated in 100% of cases and axillary hyperhidrosis in 98.5%. There were three axillary recurrences (1.5%). Of all patients, 60% suffered from transient postsympathectomy neuralgia which was mild in the majority of cases. Strong compensatory sweating occurred in 17% of patients with palmar-plantar and palmar-axillary hyperhidrosis and in 53% of patients with isolated axillary hyperhidrosis (P<0.001). In the palmar-plantar and palmar-axillary groups, 92% were very satisfied with the postoperative results, 90% reported increased quality of life, and 93% would repeat the operation. The corresponding numbers in patients with isolated axillary hyperhidrosis were 47%, 44%, and 66%, respectively (P<0.001).

Conclusion

Video-assisted thoracoscopic resection of the sympathetic chain from T2 to T4-5 is safe and effective and leads in almost 100% of cases to the elimination of palmar and axillary hyperhidrosis. In contrast to the excellent results in patients with palmar-plantar and palmar-axillary hyperhidrosis, outcome in patients with isolated axillary hyperhidrosis was impaired by a high rate of disturbing compensatory sweating.     

头面多汗症的电视胸腔镜手术治疗

目的探讨电视胸腔镜下行交感神经链切断术治疗头面多汗症的有效性和安全性。方法2003年1月至2004年12月,经电视胸腔镜行交感神经链切断术治疗头面多汗症患者18例,其中男性17例、女性1例,平均年龄36．5岁(25—42岁)。10例合并双手多汗。全身麻醉,患者取450半坐仰卧位;交感链切断位置：单纯头面多汗者在星状神经节下缘水平切断,合并双手多汗者再加做T3水平切断(1例早期病例行T2-4切除手术,3例行T：夹闭手术)。结果无严重围手术期并发症及死亡。1例1侧手术因交感链切断位置偏低,术后患者该侧头面多汗部分缓解,其余18例患者共35侧手术术后多汗症状均完全缓解,有效率97％(35／36)。平均随访8．3个月(0．5-23．0个月)．无多汗复发病例。15例(83％)出现不同程度的躯体代偿性多汗,6例(33％)于冬季时觉手掌干皴,需要涂擦适量护肤油,但均可耐受。患者对手术结局均表示满意。结论经胸腔镜的交感神经链切断手术是头面部多汗症安全有效的治疗手段。     

Thoracoscopic sympathectomy for palmar and axillary hyperhidrosis: four-year outcome and quality of life after bilateral 5-mm dual port approach

Background  During recent years, thoracoscopic sympathectomy has been the standard treatment for hyperhidrosis. Different surgical techniques have been described without proving their advantages compared with other procedures. This study was designed to evaluate our modification of thoracoscopic sympathectomy and to compare the effectiveness between axillary and palmar hyperhidrosis. Methods  Ninety patients with axillary or palmar hyperhidrosis who underwent bilateral thoracoscopic sympathectomy with single-lumen ventilation with a dual 5-mm port approach were followed up for a median of 3.9 (range, 1–6) years. The clinical course and data during the hospitalization and consultation in our outpatient clinic were reviewed. The following parameters were evaluated: clinical improvement, satisfaction, changes in quality of life, and compensatory sweating and gustatory sweating. Results  The perioperative mortality was 0, and the morbidity was 6.5%. In 81% clinical improvement of sweating was noticed; 55% did not sweat at all. A total of 88% of patients were satisfied with the result of the operation. The rates of compensatory sweating and gustatory sweating were 93.5% and 49.4%, respectively. The result of sympathectomy in patients with palmar hyperhidrosis were significantly better concerning rate of satisfaction (p = 0.006) and improvement of symptoms (p = 0.027) compared with patients with axillary symptoms. Additionally it was found that the compensatory sweating had significantly impacted the satisfaction rating of the operation. Conclusion  Currently different effective surgical approaches for the treatment of hyperhidrosis with improvement rates of more than 80% are available. The quality of the intervention has to be evaluated by changes in quality of life and intensity of compensatory sweating. Thoracoscopic sympathectomy as performed in our institution offers results and complications comparable to previously published trials; however, because of single-lumen ventilation the management is much easier. Therefore, this technique offers an interesting option for the treatment of patients with palmar and axillary hyperhidrosis.     

胸腔镜下不同节段胸交感神经链切断术治疗手汗症的疗效比较

目的探讨胸腔镜下不同节段胸交感神经切断术治疗手汗症的疗效和术后代偿性多汗的差异。方法 2006年10月-2010年8月对62例手汗症行胸腔镜下胸交感神经链切断术。A组为2006年10月-2008年11月T2-T4交感神经链切断术29例,B组为2008年12月-2010年8月T4交感神经链切除术33例。结果 62例手术均获成功,术后手掌多汗症状全部消失,有效率100%。术前合并足底多汗43例、腋窝多汗23例,术后症状消失或明显减轻分别为31例（72.1%）和20例（87.0%）。术后A组和B组均出现了不同程度的代偿性多汗：A组12例,其中10例轻度,2例中度;B组6例,其中5例轻度,1例中度,2组代偿性多汗发生率有统计学意义[41.4%（12/29）vs.18.2%（6/33）,χ2=4.031,P=0.045]。结论 T4交感神经切断术治疗手汗症能有效减少术后代偿性多汗的发生,是安全、有效的治疗方法。     

Thorascopic sympathectomy performed using laser

INTRODUCTION

Thorascopic sympathectomy is accepted as an effective treatment for palmar hyperhidrosis, facial blushing and to a lesser extent for digital ischaemia and axillary hyperhidrosis.

PATIENTS AND METHODS

Data were collected retrospectively on patients undergoing thorascopic sympathectomy at St Peter''s Hospital between 1987 and 2006. Patients were followed up by telephone interview.

RESULTS

A total of 233 thorascopic sympathectomy procedures were performed by a single operator in 123 patients. Ages ranged from 9–71 years and 75 were women. In patients, 105 had a bilateral and 13 a unilateral procedure, 5 patients had a bilateral procedure performed in two stages. In 6 upper limbs, the procedure could not be done. Overall, 110 patients (90%) had the procedure performed for palmar hyperhidrosis, 8 (6%) for facial blushing and in 5 (4%) patients the operation was performed for digital ischaemia with tissue loss. There were no deaths and all patients were discharged on day 1 following the procedure. Complications included bleeding (2), pulmonary oedema (1) and failed procedure (2); however, no incidences of Horner''s syndrome occurred. Only 40 of 123 (32.5%) patients gave follow-up information. Of this small group, 33 of 40 (83%) were cured, 4 of 40 (10%) were better, 2 of 40 (5%) were unchanged and 1 patient was worse. Only 22 out of 40 (55%) of these patients were troubled by compensatory sweating, with only 4 of 40 (10%) reporting this as a major problem.

CONCLUSIONS

Thorascopic sympathectomy is safe and can be carried out as a single bilateral procedure in the majority of cases. The laser allows the use of a single port, requires less dissection than surgical or clipping techniques, is more precise than diathermy and may be less likely to cause a Horner''s syndrome.     

胸腔镜下T3胸交感神经切断术治疗手汗症62例临床分析

目的探讨胸腔镜下T3胸交感神经切断术治疗手汗症的疗效。方法 2008年7月～2011年3月对62例手汗症行胸腔镜下经操作孔电凝钩切断T3胸交感神经及可能存在的交通支。结果 62例手术均获成功,手术时间(双侧)19～36 min,平均24.3 min。住院3～6 d,平均4.5 d。术后出现胸腔积液9例,4例行胸腔穿刺抽液,5例经保守治疗治愈。56例术后随访3～12个月,平均7.2月,2例复发轻度手汗,3例出现轻度代偿性出汗。结论胸腔镜下T3胸交感神经切断术治疗手汗症疗效确切,不易复发,术后代偿性多汗发生率低,安全性高。     

Extent of sympathectomy affects postoperative compensatory sweating and satisfaction in patients with palmar hyperhidrosis

Purpose

Endoscopic thoracic sympathectomy (ETS) for the treatment of palmar hyperhidrosis is generally performed at one or two levels ranging between T2 and T4; however, compensatory sweating (CS) is an occasional bothersome side effect. The aim of our study was to evaluate the association between the extent of ETS and the degree of postoperative CS and palmar sweating, as well as patient satisfaction.

Methods

The participants represented a consecutive series of 76 patients who underwent bilateral ETS for palmar hyperhidrosis at level T2 and/or T3. Patients were interviewed by postal questionnaires to assess their self-reported degree of postoperative palmar sweating and CS and their outcome satisfaction. Of the 53 patients who replied to the postal questionnaire, 25 underwent bilateral ETS at one level (group A), and 27 underwent bilateral ETS at two levels (group B). One patient who underwent asymmetrical sympathectomy was excluded.

Results

The degree of postoperative palmar sweating was significantly lower in group B than in group A. The severity of CS was significantly higher in group B than in group A. The severity of CS was significantly inversely correlated with the degree of patient satisfaction. However, the degree of postoperative palmar sweating was not correlated with the degree of patient satisfaction.

Conclusions

Compared to ETS at two levels, single-level ETS of T2 or T3 reduces postoperative palmar sweating to a milder degree, and causes CS to a less severe degree. The severity of CS is inversely correlated with the degree of patient satisfaction.     

Optimal targeting of sympathetic chain levels for treatment of palmar hyperhidrosis: an updated systematic review

Background

Palmar hyperhidrosis involves excessive sweating of the palms, with no known etiology. Endoscopic thoracic sympathectomy (ETS) is a safe and effective treatment for palmar hyperhidrosis, but compensatory hyperhidrosis is a common complication after ETS, leading to reduced patient satisfaction and postoperative quality of life. However, the appropriate level of the sympathetic chain to target with ETS to achieve maximum efficacy and reduce the risk of compensatory hyperhidrosis (CH) is controversial. In this systemic review, we investigated the appropriate level of sympathectomy for palmar hyperhidrosis.

Methods

PRISMA guidelines were implemented to complete a systematic review. We performed a computerized systematic literature search using PubMed and EMBASE from January 1990 to July 2016. We chose the Cochrane Collaboration’s tool and the methodological index for non-randomized studies tool for examining study bias.

Results

A total of 4075 citations were identified, of which 91 were eligible for inclusion, including 68 observational studies and 23 comparative trials. In observational studies, sympathectomies showed similar efficacies for curing PH at different levels. However, T2-free groups (i.e., at levels T3, T4, or T3–T4 combined) could render a lower risk of Horner’s syndrome (0 vs. 1.21?±?0.49%, p?=?0.036) and CH (28.75?±?7.25 vs. 57.46?±?3.86, p?=?0.002) compared with T2 involved. In comparative trials, there were 12 studies describing the comparison between T2-free ETS and T2 involved, and 9 of 12 (75%) showed T2-free ETS could reduce the incidence of CH. Overall, lowering the level and limiting the extent of sympathectomy could reduce the incidence of complications.

Conclusions

Cumulative data from more than 13,000 patients suggest that ETS is a safe, effective, and reproducible procedure with a high degree of patient satisfaction. Currently available evidence suggests that T2-free ETS may reduce the incidence of compensatory hyperhidrosis without compromising success rates and safety.

     

Endoscopic transthoracic sympathectomy for upper limb hyperhidrosis: limited sympathectomy does not reduce postoperative compensatory sweating

OBJECTIVE: Compensatory sweating is the most common and troublesome complication of thoracodorsal sympathectomy. Whether the magnitude of compensatory sweating is related to the extent of sympathectomy is unclear. We investigated the association between the extent of sympathectomy and the occurrence and severity of compensatory sweating after endoscopic transthoracic sympathectomy for upper limb hyperhidrosis. METHODS: From September 1992 to June 2000, data from patients undergoing thoracoscopic sympathectomy to treat primary upper limb hyperhidrosis in our department were prospectively collected. Routine follow-up with clinical examination was performed at 1, 3, and 6 months for the first postoperative year and every year thereafter. Late follow-up (February 2001) was with a standardized questionnaire by mail or telephone concerning compensatory sweating and patient satisfaction. Associations between the extent of sympathectomy and the occurrence and severity of compensatory sweating were analyzed with logistic regression and adjusted for age, gender, and relevant confounding factors. RESULTS: Two hundred sixty-eight sympathectomies were consecutively performed in 134 patients (99 female, 35 male; mean age, 27.8 +/- 6.7 years). In the 84 patients with palmar hyperhidrosis, eight underwent T1-T2 resection, four T1-T3 resection, eight T2-T3 resection, and 64 T2-T4 resection. In the 43 patients with palmar and axillary hyperhidrosis, eight underwent T1-T5 resection and 35 T2-T5 resection. The seven patients with isolated axillary hyperhidrosis underwent T3-T5 sympathectomy. No deaths occurred; one conversion for bleeding, one permanent Horner's syndrome, and six minor complications did occur. The initial cure rate was 99.2%. The initial satisfaction rate was 97%. The mean follow-up period was 44.3 months (range, 7 to 100 months), and complete follow-up was available in 132 patients (98.5%). Ninety-five patients (71.9%) had compensatory sweating develop. Seventy patients (53%) judged their compensatory sweating to be minor and intermittent, and 25 patients (19%) judged it severe (16% embarrassing, 3% disabling). On univariate and multivariate analysis, the extent of denervation was not associated with the occurrence or the severity of compensatory sweating. The late satisfaction rate was 91.5%. Compensatory sweating and temporary relief/recurrence were equally considered to be the main causes of dissatisfaction. CONCLUSION: Compensatory sweating was the most common long-term complication of thoracodorsal sympathectomy for primary hyperhidrosis. Its incidence and severity were not associated with the extent of sympathectomy.     

Video-assisted transthoracic sympathectomy in the treatment of primary hyperhidrosis: friend or foe?

The authors hypothesize that palmar hyperhidrosis is a systemic manifestation of abnormal sudomotor function; consequently, thoracoscopic sympathectomy to alleviate symptoms in the hands may result in heat dissipation because sweating is transferred to other sites. To investigate this phenomenon and to determine whether it adversely affects patient satisfaction, a standard questionnaire was administered to 626 patients who underwent sympathectomy at a university-associated public hospital between 1991 and 1998; only patients treated at least 6 months before questionnaire distribution were included in the study. Replies were received from 336 (53.7%) individuals. The surveyed patients underwent bilateral T2, T3 (palmar sweating), or T3, T4 (axillary sweating) sympathectomy by a standard video-assisted transthoracic technique. Main outcome measures included the incidence of dry hands, compensatory sweating, chest pain, upper-limb muscle weakness, shortness of breath, and gustatory phenomena; in addition, patient perception of the success of the surgical procedure was assessed. After sympathectomy, 97.3% (P < 0.0001) and 29.2% (P < 0.001) of patients reported significant improvement in palmar hyperhidrosis and axillary sweating, respectively. Postsurgery, severe compensatory sweating was experienced in 90% of patients (P < 0.0001). The sites of compensatory sweating were the back (75%), abdomen (51%), feet (23%), groin and thigh (13%), chest (13%), and axillae (8%). Transient whole-body sweating for no apparent reason was experienced in 30% of patients. Thirty-seven patients (11%) regretted having undergone the surgical procedure. In contrast, 25% and 64% of patients were either satisfied or very satisfied with the outcome of the procedure. From the survey results, the authors conclude that palmar hyperhidrosis is a systemic manifestation of abnormal sudomotor function and that thoracic sympathectomy may alleviate symptoms in a large proportion of patients. However, for some individuals, compensatory sweating may prove to be an equally troublesome handicap. Because the occurrence of severe compensatory sweating is unpredictable, a reversible sympathectomy may be desirable.     

Comparing T2 and T2–T3 ablation in thoracoscopic sympathectomy for palmar hyperhidrosis: a randomized control trial

Background Thoracoscopic sympathectomy is a useful therapeutic option for palmar hyperhidrosis. Surgeons differ in the level of the sympathetic chain ablated. This study aimed to compare the blockade of the T2 with levels T2 and T3 to verify the effectiveness of different ablation levels in relieving hyperhidrosis symptoms. Methods For patients undergoing bilateral thoracoscopic sympathectomy for palmar hyperhidrosis, T2–T3 ablation is performed bilaterally. In our series, 25 consecutive patients were blindly randomized to undergo unilateral T2 and T3 ablation followed by contralateral ablation of level T2 only. The patients were followed up and analyzed for comparison of symptoms bilaterally, compensatory hyperhidrosis, and levels of satisfaction postoperatively. Results The study group consisted of 25 patients with a male:female ratio of 3:2 and a mean age of 32 years (range, 19–50 years). The mean operative time was 35 min. The patients were followed up for a mean period of 23 months (range, 2–65 months). All 25 patients confirmed that their palmar sweating resolved postoperatively, with both palms equally dry. Of the 25 patients, 20 (80%) complained of compensatory hyperhidrosis, which also was bilaterally symmetric. The areas involved were trunk (80%), lower limbs (32%), and armpits (12%). Overall, 80% of the patients were very satisfied with the procedure. The remaining 20% experienced mild to moderate compensatory hyperhidrosis, which did not seem to affect their lifestyle. Conclusion The findings show that T2 ablation in thoracoscopic sympathectomy for palmar hyperhidrosis is as effective as T2–T3 ablation in terms of symptomatic relief, recurrence, compensatory hyperhidrosis, and patient satisfaction.     

Thoracoscopic versus open resection of congenital lung lesions: a case-matched study

Purpose

The purpose of the study was to compare the outcomes in children undergoing thoracoscopic versus open resection of congenital lung lesions.

Methods

Retrospective review of 12 consecutive children (<3 years of age) undergoing thoracoscopic resection of a congenital lung lesion between 2004 and 2005 was performed. Intraoperative and early postoperative results were compared with randomly selected age- and sex-matched (2:1) patients undergoing thoracotomy between 2000 and 2005.

Results

Twelve children underwent thoracoscopic resection and were compared with 24 that underwent thoracotomy. Seventy five percent of the lesions in both groups were congenital cystic adenomatoid malformations. There were no major intraoperative complications. Two thoracoscopic procedures were converted to a thoracotomy. Perioperative outcomes including operative time, length of stay, duration and volume of chest tube drainage, and dose and duration of intravenous opioids were similar for the procedures. However, children undergoing thoracoscopic procedures were less likely (odds ratio = 0.07) to have received adjunctive regional anesthesia. Overall morbidity was 33% thoracoscopic and 25% open (P = .70).

Conclusion

Thoracoscopic resection is a safe and feasible alternative to open resection of congenital lung lesions. Examination of long-term advantages of the thoracoscopic approach such as decreased risk of chest wall deformity and scoliosis and improved cosmesis will require longer follow-up.     

Efectividad de la interrupción de la transmisión nerviosa de la cadena simpática torácica bilateral con clip para el tratamiento de la hiperhidrosis palmar y/o axilar severa y el rubor facial

Introduction

Division of the thoracic sympathetic chain is the standard treatment for severe palmar and/or axillary hyperhidrosis and facial flushing. Clipping is an alternative option which allows the block to be reverted in cases of intolerable compensatory sweating.