Compensatory sweating after restricting or lowering the level of sympathectomy: a systematic review and meta-analysis

Cai, Sanjun; Shen, Ning; Li, Dongxia; Wei, Bo; An, Jun; Zhang, Junhang

doi:10.6061/clinics/2015(03)11

Cited by 12 publications

(17 citation statements)

References 25 publications

(29 reference statements)

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“…Other surgeons have suggested that lowering the level of sympathectomy could reduce severe CS 57,58 . A recent meta-analysis conducted by Cai SW et al 59 , who claimed to be the first group that conducted a meta-analysis of randomized controlled trials (RCT) on ETS to assess the effect of whether lowering the level of sympathectomy could really reduce CS, confirmed the fact that lowering the level of sympathectomy could reduce CS and severe CS after ETS.…”

Section: Discussionmentioning

confidence: 97%

A retrospective review on minimally invasive technique via endoscopic thoracic sympathectomy (ETS) in the treatment of severe primary hyperhidrosis: Experiences from the National Heart Institute, Malaysia

et al. 2018

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Background: Hyperhidrosis is due to the hyperactive autonomic stimulation of the sweat glands in response to stress. Primary hyperhidrosis is a common yet psychologically disabling condition. This study will describe our experience in managing hyperhidrosis via endoscopic thoracic sympathectomy (ETS). Methods: The information was obtained from the patient records from 1st January 2011 until 31st December 2016. Pertinent information was extracted and keyed into a study proforma. Results: 150 patients were operated on but only 118 patients were included in this study. The mean age was 22.9±7.3 years. The majority (54.2%) had palmar-plantar hyperhidrosis and 39.8% had associated axillary hyperhidrosis. Excision of the sympathetic nerve chain and ganglia were the main surgical technique with the majority (55.9%) at T2-T3 level. Mean ETS procedure time was 46.6±14.29 minutes with no conversion. Surgical complications were minimal and no Horner’s Syndrome reported. Mean hospital stay was 3.5±1.05 days. The majority of patients (67.8%) had only one follow-up and only half of the study sample (58.5%) complained mild to moderate degree of compensatory sweating, even though the long-term resolution is yet to be determined by another study. Following ETS, 98.3% of patients had instant relief and resolved their palmar hyperhidrosis. Predictors of CS were sympathectomy level and follow-up. The odds of reporting CS was 2.87 times in patients undergoing ETS at the T2-T3 level compared to those undergoing ETS at the T2-T4 level. The odds of reporting CS was 13.56 times in patients having more than one follow-up compared to those having only one follow-up. Conclusion: We conclude that ETS is a safe, effective and aesthetically remarkable procedure for the treatment of primary hyperhidrosis with only half of the patients developing mild to moderate degree of CS. Significant predictors of CS were sympathectomy level during ETS and frequency of follow-up after ETS.

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Section: Discussionmentioning

confidence: 97%

A retrospective review on minimally invasive technique via endoscopic thoracic sympathectomy (ETS) in the treatment of severe primary hyperhidrosis: Experiences from the National Heart Institute, Malaysia

et al. 2018

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“… 1 , 13 The second one is drug therapy with oxybutynin hydrochloride, an antimuscarinic drug that has been shown to be a good treatment alternative for HH in all its manifestations. 14 Studies have shown that patients who receive oxybutynin as a form of treatment have improved quality of life both in the short and in the long term in all major sites (palmar, facial, plantar and axillary) and also in unusual places (such as back and inguinal regions). 15 - 19 Its main adverse event is dry mouth, an uncomfortable event that rarely leads the patient to abandon the treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Besides these two alternatives, it is also worth mentioning topical dermatological treatments and the use of botulinum toxin. 14 …”

Section: Discussionmentioning

confidence: 99%

Epidemiologic analysis of prevalence of the hyperhidrosis

Estevan

Wolosker

et al. 2017

An. Bras. Dermatol.

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BackgroundThe present paper aims to study the prevalence of the various manifestations of hyperhidrosis in patients who sought treatment in a specialized ambulatory in the state of São Paulo.ObjectivesOpposite to previous studies, this paper studies the different combinations of sweating sites, not being restricted to the main complaint site of the patients, but taking into consideration secondary complaints patients may present.MethodsThis was a retrospective approach of a database containing more than 1200 patients in which were mapped: combination of sweating sites, age of onset, age spectrum, mean age, body mass index and gender of patients. Patients were categorized into four groups based on their main sweating site - palmar, plantar, axillary and facial.ResultsWe concluded that hyperhidrosis appears frequently in more than one site, being the main complaint that affects the most patients palmar hyperhidrosis, which appears early in the patients during adolescence. When there are two sites of sweating, the most frequent combination is palmar + plantar, and when there are three sites of sweating the most frequent combinations are palmar + plantar + axillary and axillary + palmar + plantar.Study limitationsThis research has casuistics limited to a single care service for patients with hyperhidrosis.ConclusionIt is necessary to keep in mind that the disease manifests itself mainly in more than one location, with different intensities in each of the patients, generating a significant impairment of their quality of life.

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“…Such extreme variation is attributed to different levels of sympathectomy and different methods of assessment [38]. The extent of sympathetic chain interruption was thought to factor in the development of CH; nevertheless, a systematic review [39] found no significant relation between the extent of sympathectomy and CH. In contrast, Moya and colleagues [33] reported that extended sympathectomy was associated with a lower incidence of CH.…”

Section: Commentmentioning

confidence: 99%

Sequential Extended Thoracoscopic Sympathicotomy for Palmo-Axillo-Plantar Hyperhidrosis

Elalfy

Emile

Elfeki

et al. 2017

The Annals of Thoracic Surgery

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Sequential extended thoracoscopic sympathicotomy proved to be an effective method for the treatment of combined HH because it achieved satisfactory and sustained improvement of palmar, axillary, and plantar sweating. Although the benefits of sequential extended thoracoscopic sympathicotomy outweigh its drawbacks and technical difficulties, further prospective studies are required to ascertain the effectiveness of this new technique.

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Compensatory sweating after restricting or lowering the level of sympathectomy: a systematic review and meta-analysis

Cited by 12 publications

References 25 publications

A retrospective review on minimally invasive technique via endoscopic thoracic sympathectomy (ETS) in the treatment of severe primary hyperhidrosis: Experiences from the National Heart Institute, Malaysia

A retrospective review on minimally invasive technique via endoscopic thoracic sympathectomy (ETS) in the treatment of severe primary hyperhidrosis: Experiences from the National Heart Institute, Malaysia

Epidemiologic analysis of prevalence of the hyperhidrosis

Sequential Extended Thoracoscopic Sympathicotomy for Palmo-Axillo-Plantar Hyperhidrosis

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