Thoracoscopic Sympathectomy for Axillary Hyperhidrosis: The Influence of T4

Licht, Peter B.; Jørgensen, Ole Dan; Ladegaard, Lars; Pilegaard, Hans K.

doi:10.1016/j.athoracsur.2005.02.054

Cited by 37 publications

(24 citation statements)

References 22 publications

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“…Others have also shown that restricting the extent of the sympathectomy will decrease either the incidence and/or the severity of CH [11,23,24]. However, Leseche [17] could not demonstrate differences in the incidence of CH or severe CH among patients undergoing resection of two, three, or more than three ganglia.…”

Section: Discussionmentioning

confidence: 95%

Transection of More Than One Sympathetic Chain Ganglion for Hyperhidrosis Increases the Severity of Compensatory Hyperhidrosis and Decreases Patient Satisfaction

Weksler¹,

Blaine²,

Souza³

et al. 2009

Journal of Surgical Research

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Section: Discussionmentioning

confidence: 95%

Transection of More Than One Sympathetic Chain Ganglion for Hyperhidrosis Increases the Severity of Compensatory Hyperhidrosis and Decreases Patient Satisfaction

Weksler¹,

Blaine²,

Souza³

et al. 2009

Journal of Surgical Research

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“…The former 5% complication rate for Horner syndrome from older open surgical approaches has been lowered to 1-2% with ETS. [100] Postoperative problems, such as hematoma, swelling, and pain are common with ETS. [93] Compensatory hyperhidrosis is the most common negative complication of sympathectomy, occurring in some form from 37% to as high as 100% of patients post-ETS.…”

Section: Sympathectomymentioning

confidence: 99%

“…[93] Compensatory hyperhidrosis is the most common negative complication of sympathectomy, occurring in some form from 37% to as high as 100% of patients post-ETS. [96,100] In addition, gustatory sweating (in approximately one-third of patients) and subjective phantom sweating (in approximately one-quarter of patients) can occur post-ETS. [96] Compensatory hyperhidrosis usually occurs in body segments just below the areas made dry by sympathectomy including the trunk back, buttocks, groin, and thighs.…”

Section: Sympathectomymentioning

confidence: 99%

Treatment Options for Hyperhidrosis

Walling¹,

Swick

2011

American Journal of Clinical Dermatology

121

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Hyperhidrosis is a disorder of excessive sweating beyond what is expected for thermoregulatory needs and environmental conditions. Primary hyperhidrosis has an estimated prevalence of nearly 3% and is associated with significant medical and psychosocial consequences. Most cases of hyperhidrosis involve areas of high eccrine density, particularly the axillae, palms, and soles, and less often the craniofacial area. Multiple therapies are available for the treatment of hyperhidrosis. Options include topical medications (most commonly aluminum chloride), iontophoresis, botulinum toxin injections, systemic medications (including glycopyrrolate and clonidine), and surgery (most commonly endoscopic thoracic sympathectomy [ETS]). The purpose of this article is to comprehensively review the literature on the subject, with a focus on new and emerging treatment options. Updated therapeutic algorithms are proposed for each commonly affected anatomic site, with practical procedural guidelines. For axillary and palmoplantar hyperhidrosis, topical treatment is recommended as first-line treatment. For axillary hyperhidrosis, botulinum toxin injections are recommended as second-line treatment, oral medications as third-line treatment, local surgery as fourth-line treatment, and ETS as fifth-line treatment. For palmar and plantar hyperhidrosis, we consider a trial of oral medications (glycopyrrolate 1-2 mg once or twice daily preferred to clonidine 0.1 mg twice daily) as second-line therapy due to the low cost, convenience, and emerging literature supporting their excellent safety and reasonable efficacy. Iontophoresis is considered third-line therapy for palmoplantar hyperhidrosis; efficacy is high although so are the initial levels of cost and inconvenience. Botulinum toxin injections are considered fourth-line treatment for palmoplantar hyperhidrosis; efficacy is high though the treatment remains expensive, must be repeated every 3-6 months, and is associated with pain and/or anesthesia-related complications. ETS is a fifth-line option for palmar hyperhidrosis but is not recommended for plantar hyperhidrosis due to anatomic risks. For craniofacial hyperhidrosis, oral medications (either glycopyrrolate or clonidine) are considered first-line therapy. Topical medications or botulinum toxin injections may be useful in some cases and ETS is an option for severe craniofacial hyperhidrosis.

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“…Although very effective in resolving symptoms of HH, a significant concern with ETS is the development of CH, a postsympathectomy condition of excessive sweating in a different anatomic region from the original HH manifestation 58. Reported rates of CH after sympathectomy range from 30% to 90% 59–61. Severe CH is defined as CH troublesome enough that the patient regrets undergoing ETS 57.…”

Section: Surgerymentioning

confidence: 99%

Management of hyperhidrosis

Stashak¹,

Brewer

2014

CCID

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Primary hyperhidrosis (HH), a condition of sweating in excess of thermoregulatory requirements, affects nearly 3% of the US population and carries significant emotional and psychosocial implications. Unlike secondary HH, primary HH is not associated with an identifiable underlying pathology. Our limited understanding of the precise pathophysiologic mechanism for HH makes its treatment particularly frustrating. However, a wide array of interventions for the treatment of HH have been implemented throughout the world. Herein, we discuss the most extensively studied therapeutic options for primary HH, including systemic oxybutynin, botulinum toxin injections, skin excision, liposuction–curettage, and sympathotomy/sympathectomy. We conclude with a discussion of possible future therapies for HH, including the applications of laser, microwave, and ultrasound technologies.

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Thoracoscopic Sympathectomy for Axillary Hyperhidrosis: The Influence of T4

Cited by 37 publications

References 22 publications

Transection of More Than One Sympathetic Chain Ganglion for Hyperhidrosis Increases the Severity of Compensatory Hyperhidrosis and Decreases Patient Satisfaction

Transection of More Than One Sympathetic Chain Ganglion for Hyperhidrosis Increases the Severity of Compensatory Hyperhidrosis and Decreases Patient Satisfaction

Treatment Options for Hyperhidrosis

Management of hyperhidrosis

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