Predictors of outcome following endoscopic thoracic sympathectomy

Abstract

Patient satisfaction following ETS is highest among younger patients and those undergoing the procedure for palmar hyperhidrosis. Dissatisfaction arises from failure to achieve the desired aim as well as the development of severe CS, which is more common in older patients and those undergoing ETS for axillary and scalp/facial hyperhidrosis.

Management of hyperhidrosis

“…The median age of patients was 28 years, the youngest of whom was 11 years old. ETS for palmar and craniofacial HH yielded better resolution of HH than for axillary HH, although all groups demonstrated statistically significant improvement: 97% improvement in palmar, 93% in craniofacial, and 71% in axillary HH ( P <0.001) 63. Although 75% of patients developed CH, only 12% considered it bothersome.…”

“…Although 75% of patients developed CH, only 12% considered it bothersome. The rates of severe CH were greatest in those treated for axillary HH (26%) and craniofacial HH (44.5%) and lowest in those treated for palmar HH (8%; P =0.0003) 63. Furthermore, while rates of severe CH increased with patient age, satisfaction with the results of ETS declined with age in a similar manner 63.…”

“…Furthermore, while rates of severe CH increased with patient age, satisfaction with the results of ETS declined with age in a similar manner 63. Although ETS is an effective therapy for HH, Bell et al63 emphasize the importance of transparent patient education about the risk of CH prior to surgery, as only 25% of patients who developed severe CH reported satisfaction with ETS even in light of improvement of their HH symptoms.…”

“…In a retrospective cohort study of 210 patients with palmar, axillary, and/or craniofacial HH, Bell et al63 evaluated the efficacy and incidence of adverse events with ETS as performed by a single surgeon. Electrocautery ablation was used on the sympathetic chain along its course over the second, third, and fourth ribs to target the second, third, and fourth thoracic ganglia; if identified intraoperatively, the accessory nerve(s) of Kuntz was also ablated 63.…”

“…Electrocautery ablation was used on the sympathetic chain along its course over the second, third, and fourth ribs to target the second, third, and fourth thoracic ganglia; if identified intraoperatively, the accessory nerve(s) of Kuntz was also ablated 63. The median age of patients was 28 years, the youngest of whom was 11 years old.…”