Endoscopic Transthoracic Sympathectomy in the Treatment of Hyperhidrosis

Abstract

A 5-year experience of 50 endoscopic transaxillary dorsal sympathectomies is presented. The procedure was successful in either curing or improving the symptoms of hyperhidrosis in the great majority of patients. The commonest side effects were compensatory sweating (75%) and gustatory sweating (48%); despite this, there was an extremely high level of patient satisfaction. Permanent Horner's syndrome did not occur. The procedure is effective, simple, cheap, and requires only an overnight stay; and is recommended as the method of choice for the surgical treatment of upper limb hyperhidrosis.

The treatment of primary palmar hyperhidrosis: A review

“…Using the first technique, immediate "very much to moderate" improvement of 92% of patients was reported by Byrne et al, 87 while Claes et al 88 obtained completely dry hands in 81% of patients with an additional 17% achieving some improvement. Success in either curing or improving symptoms of HH was also obtained in the majority of cases reported by Edmondson et al 45 Chao et al 89 achieved an immediate cure rate of 99.3% and Shachor et al 90 achieved dry hands in 98% of their patients, although recurrence developed within a year in 3.3%. Long-term follow-up reported by Byrne et al 87 showed that "very much to moderate" improvement was reduced to 85%.…”

Phantom sweating: a novel autonomic paresthesia

“…This symptom, although not previously reported in patients with peripheral neuropathy, has a high prevalence in patients after sympathectomy. A review of the sympathectomy literature in which phantom sweating was observed or commented upon reveals that of 1,394 patients who underwent sympathectomy (over 2,800 individual surgeries), phantom sweating was present in 547 patients (39.2%) [1][2][3][4][5][6][7][9][10][11][12][13][14]. This includes two reports of gustatory phantom sweating [5,7].…”

“…It is a common complication of sympathectomy. A review of the literature on sympathectomy in which phantom sweating was reported, revealed that phantom sweating occurs in almost 40% of patients; more frequently following open supraclavicular sympathectomy than transaxillary endoscopic sympathectomy [1][2][3][4][5][6][7][9][10][11][12][13][14]. There are no reports of phantom sweating in patients with a peripheral somatosensory or autonomic neuropathy.…”

Sequelae of endoscopic sympathetic block

“…While GS following excision of the parotid gland is caused by aberrant connections between sympathetic and parasympathetic fibers, if regenerating parasympathetic fibers run to the sudorific gland rather than the salivary glands, post-ESB GS can be considered to be due to a predominance of the parasympathetic innervation. The occurrence of GS following ESB has frequently been reported [10,21,41,43], but its etiology has not yet been explained. A significant difference in the occurrence of GS with and without video-control of the operation [42], however, cannot be explained.…”