Long-term results of a randomized controlled trial of T2 versus T2–T3 ablation in endoscopic thoracic sympathectomy for palmar hyperhidrosis

Ong, Wilson; Lee, Alvin; Tan, Wee Boon; Lomanto, Davide

doi:10.1007/s00464-015-4335-2

Cited by 19 publications

(22 citation statements)

References 33 publications

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“…CS is greater with T2-T4 resection than with T2 or T3 only or T2-T3 resection [17]. Limitation of the denervation level is the most commonly used method to decrease the incidence of complications and achieve satisfactory results [18][19][20]. The HDSS proofs a valuable asset for patient selection and quantification of the perceived severity of hyperhidrosis.…”

Section: Discussionmentioning

confidence: 99%

The risk factors of compensatory sweating in patients who have undergone one-stage bilateral single-port thoracoscopic sympathectomy for hyperhidrosis

Eşme¹

2019

Ann Clin Anal Med

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Aim: Postoperative compensatory sweating is the most common recent complication ranging from 33% to 85%. Compensatory sweating is a concern and often precludes surgery as a definitive therapy. The aim of this study is to identify the risk factors for compensatory sweating on patients who have undergone one-stage bilateral single-port thoracoscopic sympathectomy for hyperhidrosis. Material and Method: From January 2011 to December 2017 one-stage bilateral single-port thoracoscopic sympathectomy was performed for focal hyperhidrosis in 154 patients. Follow-up data were obtained from hospital charts, and the patients were supposed to answer a detailed standard questionnaire by means of a telephone interview. The data including characteristics of patients, the Hyperhidrosis Disease Severity Scale (HDSS) score, duration of surgery, hospital stay, postoperative complications, compensatory sweating, recurrence of hyperhidrosis and patient satisfaction were collected. Binary Logistic Regression Analysis was practiced to assess the association with potential risk factors for compensatory sweating. Results: Ninety-one (59%) patients were male and 63 (41%) patients were female (age range 16-47 years, mean age 24 years). T2-T3 resection was performed on 29 (18.8%) patients with craniofacial and palmar hyperhidrosis. T3-T4 resection was performed on 125 (81.2%) patients with only palmar hyperhidrosis or axillary and palmar hyperhidrosis or axillary, palmar and pedal hyperhidrosis. Compensatory sweating occurred in 24 (15.5%) patients. When patients were asked to rate the severity of their compensatory sweating, the rate is-as moderate-that by eighteen patients (75%) and as severe by six patients (25%). No intolerable compensatory sweating was reported. According to the logistic regression analysis, T2-T3 sympathectomy (OR = 6.243, p = 0.030), axillary localization hyperhidrosis (OR = 3.345, p = 0.015), and HDSS score (OR = 8.854, p = 0.001) variables were identified as risk factors for compensatory sweating occurrence. Discussion: The axillary localization hyperhidrosis, T2-T3 sympathectomy, and high HDSS score were identified as risk factors for compensatory sweating occurrence. Patients with these risks should receive extensive information for postoperative compensatory sweating.

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Section: Discussionmentioning

confidence: 99%

The risk factors of compensatory sweating in patients who have undergone one-stage bilateral single-port thoracoscopic sympathectomy for hyperhidrosis

Eşme¹

2019

Ann Clin Anal Med

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“…Traditional TS at the T2–T3 or T2–T4 levels can improve the symptoms of PH well but also increases the risk of postoperative complications (such as CS and dry hands) 3–5 . Limitation of the denervation level is the most commonly used method to decrease the incidence of complications and achieve satisfactory results 6–8 . In recent years, TS at a single level rather than at multiple levels is increasingly preferred.…”

Section: Discussionmentioning

confidence: 99%

“…Various methods have been tried to decrease the incidence of complications after TS, and limitation of the extent of surgical dissection has been found to be the key to achieving this goal. Several authors have performed TS at a single level and achieved a better curative effect (similar resolution of symptoms and lower incidence of CS) than that achieved with TS at multiple levels 6–8 . With the deepening of our understanding of TS, single-level surgeries, especially at the T3 or T4 level, became increasingly common.…”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis of T2, T3 or T4, to evaluate the best denervation level for palmar hyperhidrosis

Zhang

et al. 2017

Sci Rep

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We systematically reviewed and compared the clinical outcomes of thoracoscopic sympathectomy (TS) at different denervation levels for palmar hyperhidrosis. We searched PubMed, Ovid MEDLINE, EMBASE, Web of Science, ScienceDirect, the Cochrane Library, Scopus and Google Scholar for relevant studies published during 1990–2016. Symptom resolution, patient satisfaction, compensatory sweating (CS), recurrence, dry hands and gustatory sweating were assessed. We selected 13 studies from 2228 for the final analysis. A comparison of T2 vs. T3 TS revealed that T3 TS reduced the risk of CS (95% confidence interval [CI]: 1.36–3.19, p = 0.0007) and moderate-to-severe CS (95% CI: 2.14–7.87, p < 0.0001). No significant differences were found in patient satisfaction, symptom resolution, and incidence of dry hands and gustatory sweating. A comparison of T3 vs. T4 TS revealed that T4 TS reduced the risk of CS (95% CI: 2.87–9.53, p < 0.00001), moderate-to-severe CS (95% CI: 2.54–5.83, p < 0.00001), dry hands (95% CI: 4.07–18.13, p < 0.00001) and gustatory sweating (95% CI: 1.53–7.32, p < 0.003), and improved patient satisfaction. No significant differences were found in symptom resolution and recurrence. T4 TS appears to be more useful than T3 or T2 TS for PH.

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“…The most important side effect of sympathectomy is compensatory sweating [ 9 – 12 ]. Various studies have found controversial results regarding this side effect, which is reported to have developed in 3% to 98% of the cases [ 12 ]. In our series, compensatory sweating developed in 32 (34.7%) patients.…”

Section: Discussionmentioning

confidence: 99%

“…In our series, compensatory sweating developed in 32 (34.7%) patients. It was located mostly at the back, chest and abdominal area [ 9 – 12 ]. We did not observe any difference in the results for compensatory sweating with regard to the sympathicotomy level ( p = 0.759).…”

Section: Discussionmentioning

confidence: 99%

Single stage bilateral uniportal videothoracoscopic sympathicotomy for hyperhidrosis: can it be managed as an outpatient procedure?

Demirkaya¹,

Erşen²,

Kılıç³

et al. 2016

Videosurgery and Other Miniinvasive Techniques

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IntroductionThe videothoracoscopic approach is minimally invasive with benefits that include less postoperative pain and shorter hospital stay. It is also a safe procedure which can be performed on an outpatient basis.AimTo determine whether videothoracoscopic sympathicotomy can be performed safely in most patients as an outpatient procedure.Material and methodsBetween July 2005 and October 2015, a total of 92 patients underwent bilateral and single port thoracoscopic sympathicotomy in our department on an outpatient basis. The level of sympathicotomy was T2 in 2 (2.2%) patients, T2 to T3 in 31 (33%) patients, T2 to T4 in 46 (50%) patients and T3 to T4 in 12 (13%) patients. Demographic data, length of postoperative stay, substitution index (SI), admission rate (AR) and readmission rate (RR), complications and patient satisfaction were reviewed retrospectively.ResultsTwo (2.2%) patients suffered from chest pain, while 4 (4.3%) patients complained about pain at the port site. Mean discharge time after surgery was 5.1 h (range: 4–6 h), mean duration of hospital stay was 0.15 days (0–3 days) postoperatively and the mean operation time was 43.6 min (15–130 min). In 8 (8.6%) patients, pneumothorax was detected on postoperative chest X-ray, while 5 (5.4%) patients required chest tube drainage. Mild or moderate compensatory sweating developed in 32 (34.7%) patients. No recurrence was observed, and the satisfaction rate was 96.7%. Substitution index and admission rate were 91.3% and 11% respectively, while RR was 0%.ConclusionsBilateral video-assisted thoracoscopic sympathicotomy can be performed safely in most patients as an outpatient procedure.

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Long-term results of a randomized controlled trial of T2 versus T2–T3 ablation in endoscopic thoracic sympathectomy for palmar hyperhidrosis

Abstract: There was no difference in recurrence rates and CH between single-level (T2) and multi-level (T2-T3) ETSs in the long term.

Cited by 19 publications

References 33 publications

The risk factors of compensatory sweating in patients who have undergone one-stage bilateral single-port thoracoscopic sympathectomy for hyperhidrosis

The risk factors of compensatory sweating in patients who have undergone one-stage bilateral single-port thoracoscopic sympathectomy for hyperhidrosis

A systematic review and meta-analysis of T2, T3 or T4, to evaluate the best denervation level for palmar hyperhidrosis

Single stage bilateral uniportal videothoracoscopic sympathicotomy for hyperhidrosis: can it be managed as an outpatient procedure?

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