Is T3 and T6 Sympathetic Clipping More Effective in Primary Palmoplantar Hyperhydrosis?

Abstract

Objective: Our aim was to establish a standardized approach for patients with palmoplantar and axillary hyperhidrosis and to compare patient satisfaction and complication rates for two different operations. Materials and Methods: Between 2008 and 2010, 30 patients underwent conventional T3/4 clipping (group A), and 30 underwent only T3 and T6 clipping (group B). Both groups were compared with regard to compensatory sweating (CS), complications, patient satisfaction and recovery of plantar hyperhidrosis. Results: The CS rate was 60 % in group A and 47 % in group B. CS was significantly less in group B compared to group A (p ≤ 0.001). The plantar hyperhidrosis recovery rate was higher in group B (n = 19) compared to group A (n = 13), but the difference was not statistically significant (p ≥ 0.299). Patient satisfaction rate was 93.3 % in group A and 96.6 % in group B. Conclusions: Our study showed that T3/6 clipping was as effective as T3/4 clipping for palmar and axillary hyperhidrosis. Our results revealed that this technique is more effective than T3/4 sympathectomy to treat plantar hyperhidrosis.

hyperhidrosis - thoracoscopy/VATS - mediastinum (incl. mediastinoscopy)

References

• 1 Tetteh H A, Groth S S, Kast T et al. Primary palmoplantar hyperhidrosis and thoracoscopic sympathectomy: a new objective assessment method.  Ann Thorac Surg. 2009;  87 (1) 267-275
• 2 Gossot D, Toledo L, Fritsch S, Célérier M. Thoracoscopic sympathectomy for upper limb hyperhidrosis: looking for the right operation.  Ann Thorac Surg. 1997;  64 975-978
• 3 Miller D L, Force S D. Temporary thoracoscopic sympathetic block for hyperhidrosis.  Ann Thorac Surg. 2008;  85 (4) 1211-1214
• 4 Lin C C, Mo L R, Lee L S, Ng S M, Hwang M H. Thoracoscopic T2-sympathetic block by clipping – a better and reversible operation for treatment of hyperhidrosis palmaris: experience with 326 cases.  Eur J Surg Suppl. 1998;  580 13-16
• 5 Baumgartner F J, Bertin S, Konecny J. Superiority of thoracoscopic sympathectomy over medical management for the palmoplantar subset of severe hyperhidrosis.  Ann Vasc Surg. 2009;  23 (1) 1-7
• 6 Baumgartner F J. Surgical approaches and techniques in the management of severe hyperhidrosis.  Thorac Surg Clin. 2008;  18 (2) 167-181
• 7 Liu Y, Yang J, Liu J et al. Surgical treatment of primary palmar hyperhidrosis: a prospective randomized study comparing T3 and T4 sympathicotomy.  Eur J Cardiothorac Surg. 2009;  35 (3) 398-402
• 8 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 (4) 1227-1233
• 9 Hsu C P, Chen C Y, Hsia J Y, Shai S E. Resympathectomy for palmar and axillary hyperhidrosis.  Br J Surg. 1998;  85 (11) 1504-1505
• 10 Neumayer C, Zacherl J, Holak G et al. Limited endoscopic thoracic sympathetic block for hyperhidrosis of the upper limb: reduction of compensatory sweating by clipping T4.  Surg Endosc. 2004;  18 (1) 152-156
• 11 Gray H. The sympathetic nerves. In: Lewis W H, ed. Anatomy of the Human Body. 20th ed. Philadelphia: Lea/Febiger; 2000: 1292-1299
• 12 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 (3) 1048-1055
• 13 Baumgartner F J, Toh Y. Severe hyperhidrosis: clinical features and current thoracoscopic surgical management.  Ann Thorac Surg. 2003;  76 (6) 1878-1883
• 14 Hsia J Y, Chen C Y, Hsu C P, Shai S E, Yang S S. Outpatient thoracoscopic limited sympathectomy for hyperhidrosis palmaris.  Ann Thorac Surg. 1999;  67 (1) 258-259
• 15 Weksler B, Blaine G, Souza Z B, Gavina R. Transection of more than one sympathetic chain ganglion for hyperhidrosis increases the severity of compensatory hyperhidrosis and decreases patient satisfaction.  J Surg Res. 2009;  156 (1) 110-115
• 16 Whitson B A, Andrade R S, Dahlberg P S, Maddaus M A. Evolution of clipping for thoracoscopic sympathectomy in symptomatic hyperhidrosis.  Surg Laparosc Endosc Percutan Tech. 2007;  17 (4) 287-290
• 17 Sugimura H, Spratt E H, Compeau C G, Kattail D, Shargall Y. Thoracoscopic sympathetic clipping for hyperhidrosis: long-term results and reversibility.  J Thorac Cardiovasc Surg. 2009;  137 (6) 1370-1377
• 18 Oh C S, Chung I H, Koh K S, Kim H J, Kim S S. Intradural anastomoses between the accessory nerve and the posterior roots of cervical nerves: their clinical significance.  Clin Anat. 2001;  14 (6) 424-427