Primary hyperhidrosis. Current status of surgical treatment

Up-to-date Treatments of Primary Hyperhidrosis with Focus on Sympathectomy and Sympathicotomy; A Narrative Review

“…Complications from the use of topical agents are occlusion and atrophy of the sweat glands, skin irritation, the brown discoloration of the skin, irritation and the rebound effect. The effectiveness of the treatment decreases with continuing therapy [10].…”

“…Although most are performed under general anesthesia with selective or common tracheal intubation, some use simple tracheal intubation for lung collapse and better exposure use CO2 insufflation. Local anesthesia may also be used for these surgeries [1,9,10,19]. The most common patient position during surgery is semi-sitting or sitting with 90° abduction of the upper extremities (semi-Fowler position).…”

“…The sympathetic ganglia dermatomes overlap each other, but it appears that the T2 ganglion is mostly engaged in innervation of the head, neck, and upper extremity. The T3 ganglion is engaged in the innervation of the upper extremity and upper third of the axillary fossa, and the T4 ganglion is engaged in innervation of the upper extremity and lower third of the axillary fossa [9,10,20,21].…”

“…Some surgeons use a draining tube connected to a sealing system to evacuate the pneumothorax. When there is no lung injury, pneumothorax, or plural effusion, the draining tube is removed sometime after surgery [10], although many others insert a small catheter at the end of the operation and remove it by performing a valsalva maneuver [19].…”

“…Satisfaction and cure rates after surgery for axillary hyperhidrosis are reported to be 72.2%-93%, followed by 43%-60% for plantar and craniofacial hyperhidrosis. Failure rates in technique are reported to be 0%-2% for sympathectomy and 3.4%-5% for sympathetic clipping [3,9,10,17,21,24].…”