Sustained Benefit Lasting One Year from T4 Instead of T3-T4 Sympathectomy for Isolated Axillary Hyperhidrosis

Abstract

Munia MAS, Wolosker N, Kaufmann P, Milanez de Campos JR, Puech-Leão P. Sustained benefit lasting one year from T4 instead of T3-T4 sympathectomy for isolated axillary hyperhidrosis. Clinics. 2008;63:771-4. INTRODUCTION:Level T4 video-assisted thoracoscopic sympathectomy proved superior to T3-T4 treatment for controlling axillary hyperhidrosis at the initial and six-month follow-ups of these patients. OBJECTIVE: To compare the results of two levels of sympathectomy (T3-T4 vs. T4) for treating axillary sudoresis over one year of follow-up. METHODS: Sixty-four patients with axillary hyperhidrosis were randomized to denervation of T3-T4 or T4 alone and followed prospectively. All patients were examined preoperatively and were followed postoperatively for one year. Axillary hyperhidrosis treatment was evaluated, along with the presence, location, and severity of compensatory hyperhidrosis and self-reported quality of life. RESULTS: According to patient reports after one year, all cases of axillary hyperhidrosis were successfully treated by surgery. There were no instances of treatment failure. After six months, compensatory hyperhidrosis was present in 27 patients of the T3-T4 group (87.1%) and in 16 patients of the T4 group (48.5%). After one year, all T3-T4 patients experienced some degree of compensatory hyperhidrosis, compared to only 14 patients in the T4 group (42.4%). In addition, compensatory hyperhidrosis was less severe in the T4 patients (p < 0.01). Quality of life was poor before surgery, and it improved in both groups at six months and one year of follow-up (p = 0.002). There were no cases of mortality, no significant postoperative complications, and no need for conversion to thoracotomy in either group. CONCLUSION: Both techniques were effective for treating axillary hyperhidrosis, but the T4 group showed milder compensatory hyperhidrosis and greater patient satisfaction at the one-year follow-up.

Sympathectomy for Palmar Hyperhidrosis

“…Bilateral VATS is an effective and safe choice of treatment for palmar hyperhidrosis with low morbidity-mortality rates, good cosmetic results, less postoperative pain, and short hospitalization [5,[11][12][13]. Success rate of VATS changes from 88 to 100 % [1,2,9,11,14]. We observed improvement of symptoms in 95 % in our study.…”

“…Carbon dioxide insufflation was not used in our operations like in most of the studies that were done before [2,5,[8][9][10][12][13][14]. Semi-seated position of the patient and lowvolume high-frequency ventilation provide enough visualization of sympathetic chain.…”

A New Target of Percutaneus Sympathic Radiofrequency Thermocoagulation for Treatment of Palmar Hyperhidrosis: T4

“…[5] The most recommended technique is videoscopic thoracoscopic sympathectomy. [5,[11][12][13][14][15][16][17][18][19][20] Surgical techniques have some potential complications such as pneumothorax, hemothorax, atelectasia, Horner syndrome, compensatory hyperhidrosis (CH), excessive dryness, bradycardia and cardiac arrest. [1,5,11,12] The preferred surgical sympathectomy levels in palmar hyperhidrosis are T2, T3, T2-3, T4, T3-4.…”

“…[1,5,11,12] The preferred surgical sympathectomy levels in palmar hyperhidrosis are T2, T3, T2-3, T4, T3-4. [1,2,5,[11][12][13][14][15][16][17][18][19][20][21][22] From the first introduction of surgical sympathectomy in the literature, the researches are continuing to find the most effective level with least complications. [1,2,5,[13][14][15][16][17][18][19][20] Recent researches have advocated the surgical sympathectomy of T4 sympatheic truncus has lesser adverse effects with better patient satisfaction rates.…”

“…[1,2,5,[13][14][15][16][17][18][19][20] Recent researches have advocated the surgical sympathectomy of T4 sympatheic truncus has lesser adverse effects with better patient satisfaction rates. [1,5,[13][14][15][18][19][20] However, there is need for additional studies.…”