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

Abstract

<ns4:p><ns4:bold>Background</ns4:bold>: 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).</ns4:p><ns4:p> <ns4:bold>Methods: </ns4:bold>The information was obtained from the patient records from 1<ns4:sup>st</ns4:sup> January 2011 until 31<ns4:sup>st</ns4:sup> December 2016. Pertinent information was extracted and keyed into a study proforma.</ns4:p><ns4:p> <ns4:bold>Results: </ns4:bold> 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.</ns4:p><ns4:p> <ns4:bold>Conclusion: </ns4:bold>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.</ns4:p>

Thoracoscopic sympathectomy for treatment of primary hyperhidrosis in children: a randomized comparative study between clipping and electrocautery techniques

“…2 In the study of Musa AF et al, one patient developed a rare complication in the form of bradycardia. 6 In our study 70% of group A and 75% of group B developed compensatory sweating and it was ranging from mild to severe degree. The same results was found in the study of Findikcioglu A et al, as 71.4% (17.9 severe degree) from the cautery group and 71.9% (18.8 severe degree) from the clipping group developed compensatory sweating and the difference between the 2 groups was statistically insignificant (P = 0.8).…”

Does endoscopic thoracic sympathectomy improve the quality of life of patients with primary hyperhidrosis? A single center retrospective review

“…Therefore, we suggest the number of location(s) involved in CS to be considered as a confounder to postoperative QOL for future research. The clinical implication of this study is that with the high incidence of CS reported in this study and our previous study, 17 which can be associated with the involvement of T2 resection, it may be proposed to our institute regarding reducing ETS surgery that involves T2 resection. This suggestion is backed by the literature, which claims that symptom resolution was not significantly different between T2-involved and T2-spared group, but incidence of CS was significantly higher in the T2-involved group 26,36 .…”

“…Besides, we could not yield a similar finding to those found in our previous study 17 as our sample size is relatively small compared to previous studies. Furthermore, as this study is a continuation of the previous study 17 , different study populations used in the different studies may explain variations in the results. However, we believe that more surgeries sparing T2 should be carried out in order for further analysis on such association to be done.…”

“…In addition, pilot tests were run with ten volunteers to gain feedback to improve the process of interview. These were patients from our previous cohort of study on ETS 17 and no changes were made to the questionnaire after the pilot study.…”

“…On the other hand, one study concluded that postoperative QOL did not depend solely on the severity of CS, but also on the ability of patients to tolerate the situation. 16 It is also worth noting that besides traditional outcome data, complication rate and morbidity, as we have presented in our previous research 17 , and QOL analyses were also used as benchmarks of the success of such surgical procedure. But it is also noted that some QOL questionnaires are lacking in quality, and in deriving substantive conclusions.…”