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DOI: 10.1055/s-0030-1250646
© Georg Thieme Verlag KG Stuttgart · New York
Preserving T2 in Thoracic Sympathicotomy for Palmar Hyperhidrosis: Less Tissue Trauma, Same Effectiveness
Publication History
received May 28, 2010
Publication Date:
15 March 2011 (online)
![](https://www.thieme-connect.de/media/thoracic/201106/lookinside/thumbnails/10.1055-s-0030-1250646-1.jpg)
Abstract
Background: The aim of this study was to compare two different sympathicotomy procedures for primary hyperhidrosis in terms of compensatory sweating, complications, safety and effectiveness. Methods: The data of 78 consecutive patients who underwent bilateral endoscopic thoracic sympathicotomy (156 laterals) for palmar hyperhidrosis between January 2005 and September 2009 were studied retrospectively. The first 29 consecutive patients were treated with a T2–3 sympathicotomy (Group A). After November 2007, all patients (49 patients) were treated with a T3 sympathicotomy alone (Group B). The chest tubes were always removed after checking for pneumothorax with roentgenography. All patients were followed up and evaluated for results, side effects, complications, and satisfaction levels. The differences between the two groups were analyzed. Results: The mean age of the 47 (60.2 %) female and 31 (39.8 %) male patients was 25.2 years. Horner's syndrome and pneumothorax was not detected in either group. The mean follow-up time was 20.82 months (6–52 months). Effectiveness of the procedure at the time of discharge and at follow-up was 100 % and 97.5 %, respectively. There was no significant difference between groups with regard to any analyzed parameter. Conclusion: This study demonstrates that preserving the T2 ganglion is safe, and does not compromise the effectiveness of the procedure. Sympathicotomy has the same success rate as sympathectomy, but requires significantly less dissection and results in less tissue trauma.
Key words
hyperhidrosis - sympathicotomy - compensatory sweating
References
- 1 Rodríguez P M, Freixinet J L, Hussein M et al. Side effects, complications and outcome of thoracoscopic sympathectomy for palmar and axillary hyperhidrosis in 406 patients. Eur J Cardiothorac Surg. 2008; 34 514-519
- 2 Licht P B, Pilegaard H K. Severity of compensatory sweating after thoracoscopic sympathectomy. Ann Thorac Surg. 2004; 78 427-431
- 3 Keller S M, Lin C C. Surgical treatment of hyperhidrosis.. In: Sellke F W, Del Nido P J, Swanson S J, eds. Sabiston & Spencer Surgery of the Chest.. Philadelphia, PA: Elsevier Saunders; 2005: 703-709
- 4 Li X, Tu Y R, Lin M, Lai F C, Chen J F, Dai Z J. Endoscopic thoracic sympathectomy for palmar hyperhidrosis: a randomized control trial comparing T3 and T2–4 ablation. Ann Thorac Surg. 2008; 85 1747-1751
- 5 Mahdy T, Youssef T, Elmonem H A, Omar W, Elateef A A. T4 sympathectomy for palmar hyperhidrosis: looking for the right operation. Surgery. 2008; 143 784-789
- 6 Li X, Tu Y R, Lin M, Lai F C, Chen J F, Miao H W. Minimizing endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: guided by palmar skin temperature and laser Doppler blood flow. Ann Thorac Surg. 2009; 87 427-431
- 7 Kwong K F, Krasna M J. Thoracoscopic sympathectomy.. In: Shields T W, Lo Cicero III J, Reed C E, Feins R H, eds. General Thoracic Surgery.. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009: 657-660
- 8 Lin T S, Wang N P, Huang L C. Pitfalls and complication avoidance associated with transthoracic endoscopic sympathectomy for primary hyperhidrosis (analysis of 2200 cases). Int J Surg Invest. 2001; 2 377-385
- 9 Schmidt J, Bechara F G, Altmeyer P, Zirngibl H. Endoscopic thoracic sympathectomy for severe hyperhidrosis: impact of restrictive denervation on compensatory sweating. Ann Thorac Surg. 2006; 81 1048-1055
- 10 Dewey T M, Herbert M A, Hill S L, Prince S L, Mack M J. One-year follow-up after thoracoscopic sympathectomy for hyperhidrosis: outcomes and consequences. Ann Thorac Surg. 2006; 81 1227-1233
- 11 Gossot D, Galetta D, Pascal A et al. Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis. Ann Thorac Surg. 2003; 75 1075-1079
- 12 Fredmann B, Zohar E, Shachor D, Bendahan J, Jedeikin R. Video-assisted transthoracic sympathectomy in the treatment of primary hyperhidrosis: friend or foe?. Surg Laparosc Endosc Percutan Tech. 2000; 4 226-229
- 13 Reisfeld R. Sympathectomy for hyperhidrosis: should we place the clamps at T2–T3 or T3–T4?. Clin Auton Res. 2006; 16 384-389
- 14 Leseche G, Castier Y, Thabut G et al. Endoscopic transthoracic sympathectomy for upper limb hyperhidrosis: limited sympathectomy does not reduce postoperative compensatory sweating. J Vasc Surg. 2003; 37 124-128
- 15 Chiou T S, Chen S C. Intermediate-term results of endoscopic transaxillary T2 sympathectomy for primary palmar hyperhidrosis. Br J Surg. 1999; 86 45-47
- 16 Hashmonai M, Kopelman D, Kein O, Schein M. Upper thoracic sympathectomy for primary palmar hyperhidrosis: long-term follow-up. Br J Surg. 1992; 79 268-271
- 17 Hsu C P, Shia S E, Hsia J Y, Chuang C Y, Chen C Y. Experiences in thoracoscopic sympathectomy for axillary hyperhidrosis and osmidrosis: focusing on the extent of sympathectomy. Arch Surg. 2001; 10 1115-1117
- 18 Kwong K F, Cooper L B, Bennett L A, Burrows W, Bamliel Z, Krasna M J. Clinical experience in 397 consecutive thoracoscopic sympathectomies. Ann Thorac Surg. 2005; 80 1063-1066
- 19 Chung I H, Oh C S, Koh K S, Kim H J, Paik H C, Lee D Y. Anatomic variations of the T2 nerve root (including the nerve of Kuntz) and their implications for sympathectomy. J Thorac Cardiovasc Surg. 2002; 123 498-501
- 20 Singh B, Ramsaroop L, Partab P, Moodley J, Satyapal K S. Anatomic variations of the second thoracic ganglion. Surg Radiol Anat. 2005; 27 119-122
- 21 Noppen M P, Vincken W G. Partial pulmonary sympathetic denervation by thoracoscopic D2–D3 sympathicolysis for essential hyperhidrosis: effect on the pulmonary diffusion capacity. Respir Med. 1997; 91 537-545
- 22 Noppen M, Dendale P, Hgers Y, Herregodts P, Vincken W, D'Haens J. Changes in cardiocirculatory autonomic function after thoracoscopic upper dorsal sympathicolysis for essential hyperhidrosis. J Autonom Nerv Sys. 1996; 60 115-120
Dr. Kutsal Turhan
Department of Thoracic Surgery
Ege University Medical Faculty
Izmir 35100
Turkey
Phone: +90 23 23 90 46 80
Fax: +90 23 23 90 46 81
Email: kutsal.turhan@ege.edu.tr