Two-stage unilateral versus one-stage bilateral single-port sympathectomy for palmar and axillary hyperhidrosis

Abstract

Both two-stage unilateral and one-stage bilateral single-port video-assisted thoracoscopic sympathectomies are effective, safe and minimally invasive procedures. Two-stage unilateral sympathectomy can be performed with a lower occurrence of compensatory sweating, improving permanently the quality of life in patients with palmar and axillary hyperhidrosis.

Simpatectomia torácica por videotoracoscopia: revisão da literatura.

“…Postoperative pain requiring analgesics for more than one week was recorded in thirteen patients (13%), with only three patients (3%) needing more than paracetamol after two weeks (17.3 days). 15 . In the fourth, the mean operative time for each side was 15 minutes for T3-T4 sympathectomy and 28 minutes for T2-T4 sympathectomy 18 .…”

“…Sixteen (12%) patients in the one-stage group and 15 (11%) patients in the two-stage one suffered mild to moderate pain.Compensatory hyperhidrosis occurred in25 (19%) patients in the one-stage group and in six (4%) of the two-stage one. This allows to consider that the two-stage approach could render lower probability of development of compensatory hyperhidrosis than the one-stage15 .Another study, with 120 patients with primary palmar hyperhidrosis, randomly divided subjects into two groups, electrocautery hook group (60 patients) and titanium clip group (60 patients).All patients underwent sympathetic block at the T4 level. The postoperative follow-up period was two months and all patients were cured.…”

Management of hyperhidrosis

“…Sympathotomy and sympathectomy are the most invasive procedures for HH, but for those patients whose daily lives are disrupted by HH, despite trials of other therapeutic options, sympathetic chain disruption may present an appealing opportunity for treatment 19,57,63,70–73. Certainly, the risk of CH should be discussed thoroughly with patients considering this intervention 58,62,63. In order to limit the risk of CH and chest wall pain, paresthesias, and scars,74,75 experimentation with altering the techniques and levels disrupted during sympathotomy/sympathectomy continues 57,58,65–72.…”

“…Initially recommended in the treatment of peptic ulcer disease and other maladies,56 ETS has since been applied successfully to the treatment of primary HH, particularly of the palms and soles 19,57. 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.…”

Thoracoscopic sympathectomy using single port versus multiple ports as a treatment for palmar hyperhidrosis

“…These symptoms usually begin in childhood or adolescence, often representing an incapacitating and embarrassing disorder that can interfere with social and professional activities. (2) Early surgical management for hyperhidrosis required an open thoracotomy. This was accompanied by a prolonged recovery period and significant morbidity including Horner's syndrome.…”