Long-term outcomes associated to video-assisted thoracic sympathotomy for palmar-axillar subtype of the hyperhidrosis

Abstract

OBJECTIVE: Surgery for both palmar and axillar hyperhidrosis usually includes the interruption of the sympathetic chain in multiple levels. This study aimed to determine the long-term outcomes associated to video-assisted thoracic sympathotomy (VATS) of T2, T3 and T4 ganglia for these cases. METHODS: Analysis of the outcomes obtained from 36 patients regarding the rate of resolution of the symptoms and the compensatory sweating (CS). All subjects were followed-up for 36 months. RESULTS: Good outcomes were observed in 98.6% for palmar and 60% for axillary hyperhidrosis (p=0.0423), respectively. Of the subjects, 86% reported some postoperative episode of CS, however only 45% (p=0.0031) still noticed it at the end of the follow-up period. CONCLUSIONS: VATS is effective for the excessive palmar sweating, whereas it is fully efficient for only two thirds of the cases sustaining associated axillar hyperhidrosis. CS is expected as a rule following the proposed operative protocol, however it is usually self-limited.

Evaluación de la satisfacción con el resultado clínico después de 10 años de simpatectomía videotoracoscópica bilateral para el manejo de la hiperhidrosis primaria

“…En los estudios latinoamericanos, el seguimiento a largo plazo no sobrepasa los ocho años 6,[14][15][16][17][18][19][20] . A nivel global, los estudios con mayor seguimiento son el de Askari, et al 3 , con 51 pacientes evaluados en promedio durante 77 meses (rango 6 a 189 meses), después de la simpatectomía torácica bilateral, y el de Zacherl, et al 10 , con 293 pacientes con seguimiento mayor de 15 años.…”

Up-to-date Treatments of Primary Hyperhidrosis with Focus on Sympathectomy and Sympathicotomy; A Narrative Review

“…The new nomination system uses the number of ribs upon which the sympathetic chain is cut (R) instead of the number of sympathetic ganglion (T) [1,6,22]. These manipulations on the sympathetic chain are carried out via different devices and techniques, such as electrocautery (monopolar or bipolar), the Harmonic scalpel, radiofrequency, and clamping [23][24][25][26]. To increase the surgical success rate and decrease recurrence, any accessory nerve tract to other ganglions and to intercostal nerves (Kuntz's fibers) must be disconnected [27].…”

“…Satisfaction and cure rates after surgery for axillary hyperhidrosis are reported to be 72.2%-93%, followed by 43%-60% for plantar and craniofacial hyperhidrosis. Failure rates in technique are reported to be 0%-2% for sympathectomy and 3.4%-5% for sympathetic clipping [3,9,10,17,21,24].…”