Video-Assisted Thoracoscopic Bilateral Sympathectomy for Primary Hyperhidrosis in Zagazig University Hospitals

Abstract

Background:. Hyperhidrosis is the condition characterized by abnormally increased sweating/perspiration in excess of that required for regulation of body temperature. Hyperhydrosis can be primary or secondary. Primary hyperhidrosis is idiopathic in nature and the most affected regions are palms , axillae and feet. Palmar and axillo-palmar hyperhidrosis is a disabling disorder. It usually has negative impact on the patient's social and professional life.The incidence of primary hyperhydrosis is estimated to be around 0.6 to 1%. Management strategies to hyperhidrosis may be classified as nonsurgical or surgical Treatment. Thoracoscopic sympathectomy is considered the most effective and durable treatment for patients suffering from moderate to severe hyperhidrosis with good short-term results and minimal postoperative complications Aim of the work: The aim of the work is to evaluate and compare the immediate and long-term outcomes of video-assisted thoracoscopic sympathectomy in the treatment of primary hyperhidrosis.Patients and Methods: From Jul. 2012 to Jun. 2017, a prospective study was conducted on fifty six patients, admitted to surgery Departments, zagazig university hospitals scheduled for bilateral thoracoscopic sympathectomy,for the treatment of primary hyperhydrosis involving the palms of both hands in all patients with or without involvement of the axillae.All the patients were considered in grades 3 or 4 of the HDSS in which their lifestyle and occupation were markedly affected.The sample included38 (67.9%) males and 18 (32.1%) female with mean age of 27.03±4.89.Statistical analysis: SPSS version 20. Results: In total number of 56 patients with primary hyperhidrosis who passed bilateral thoracoscopic sympathectomy, it was found that all patients had immediate stoppage of palmar hyperhidrosis. The mean hospital stay was1.08±0.28.Good Satisfaction had occurred in 51 cases(91.1%)The most common postoperative troublesome was pleuritic chest pain in 18 cases(32.1%) .Compensatory sweating had occurred in 4 cases(7.1%). 4cases had developed postoperative pneumothorax. Conclusion:Video-assisted thoracoscopic bilateral sympathectomy is a rapid, reliable and safe technique. It presents important advantages over the staged procedures because it can be done in a single surgical procedure, requires placement of only two thoracic ports, avoiding the third port. The transaxillary bilateral approach provides as good if not better results and can certainly be done with similar or perhaps less morbidity. Furthermore, the bilateral approach reduces the time of patient recovery and reduces healthcare costs.