How to Prevent, Reduce, and Treat Severe Post Sympathetic Chain Compensatory Hyperhidrosis: 2021 State of the Art

Abstract

The role of thoracic surgery in the management of hyperhidrosis is well-known and thoracoscopic sympathetic interruption is commonly accepted as being the most effective treatment. However, some concerns still remain regarding the potential to develop compensatory hyperidrosis (CH), the most troublesome and frequent side effect after surgery and its management. Compensatory hyperidrosis prevention may be achieved by identifying subjects at higher risk and/or targeting nerve interruption level on the base of single patient characteristics gathered during the preoperative survey. Furthermore, the surgical treatment may consist of different techniques aimed at reversing the effects of previous sympathetic interruption. To predict CH after sympathectomy, the most interesting proposals in recent literature are a temporary thoracoscopic sympathetic block and the introduction of new and targeted preoperative surveys. If the role of nerve clipping technique vs. the definitive cutting is still intensely under debated, new approaches have been recently proposed to reduce the incidence of CH. In particular, extended sympathicotomy has been described as an alternative to overcome severe forms. Last, among the techniques developed to reverse sympathetic interruption effect, diffuse sympathicotomy (DS) and microsurgical sympathetic trunk reconstruction represent advances in this field. An all-round review of these topics is strongly needed. Our aim is to cover all the above issues point by point. Although sympathectomy represents a small part of thoracic surgery, we believe that it is worthy of interest because of the profound effect that complications for a benign condition can have on patients.

Surgical management of compensatory sweating: A systematic review

“…The risk of developing compensatory hyperhidrosis is influenced by many variables. If we consider all forms of compensatory hyperhidrosis, from the lightest to the most severe, the percentage of subjects that is affected in the literature can reach up to 98% ( 2 , 17 ).…”

“…Several authors have pointed out that surgery for the craniofacial hyperhidrosis, therefore surgery on T2, increases the risk of CS ( 17 ). Sympathectomy at the T2 level probably causes interruption of the negative feedback to the hypothalamus and this seems to be shown to be the district most at risk for the development of CH ( 2 , 18 ).…”

“…The efficacy of a diffuse sympathectomy can also be considered for preventive purposes, performing it directly during the first operation for sympathectomy for hyperhidrosis ( 17 ).…”

Robotic Sympathectomy for Hyperhidrosis

“…A very common side effect of the procedure is compensatory hyperhidrosis [ 6 ]. Although the pathophysiology of compensatory hyperhidrosis is poorly known, it has been proposed that a malfunctioning reflex arc from the sympathetic nervous system to the hypothalamus may be the primary cause of excessive, sudden, and uncontrolled sweating in other regions of the body [ 7 ]. Due to the risk of secondary effects, only patients with extreme perspiring that is affecting their daily existence and who have not reacted to different medicines should consider this procedure [ 6 ].…”

Compensatory Hyperhidrosis After Non-Surgical Treatment of Primary Focal Hyperhidrosis: Two-Year Single-Centered Prospective Study From Jordan

“…1,2 It affects approximately 3% of the population worldwide and poses a significant problem in the private, mental, social, and professional life of the patients, and has been shown to have a negative impact on the daily activities of those affected resulting in a reduced quality of life (QoL). 3,4 The underlying mechanism of PH is still unclear, but a strong genetic predisposition with sympathetic nervous dysfunction of the sweat glands has been suggested as a cause. 5 Diagnosis is mainly based on the clinical history of the patient and evaluation that includes the exclusion of other disorders that may cause excessive sweating.…”