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Abstract
Compensatory hyperhidrosis is a debilitating postoperative condition occurring in 30% to 90% of patients with primary hyperhidrosis. The most appropriate treatment for compensatory hyperhidrosis remains controversial.Between January 2018 and December 2019, 44 patients with intractable compensatory hyperhidrosis underwent diffuse sympathicotomy (DS). In the early study periods, DS was performed sparsely (limited DS) to avoid possible adverse effects (right R5/7/9/11, left R5/6/8/10). In the late study periods, levels of surgical interruption were further modified to maximize sympatholytic effects (extended DS; bilateral R5/6/7/8/9/10/11). Patients were followed up for symptom resolution. For objective evidence of improved hyperhidrosis, thermographic images were taken for 7 patients.Immediate resolution of compensatory hyperhidrosis was achieved in 81% of patients, as determined at the 1 to 2 week postoperative visit. With a median follow-up of 22.7 months, compensatory hyperhidrosis continued to be resolved in 46% (n = 20). Logistic regression analysis showed that persistent resolution of compensatory hyperhidrosis was independently predicted by extended DS (odds ratio, 25.67, 95% CI, 1.78-1047.6; P = .036). The presence of gender, BMI, isolated compensatory hyperhidrosis, distribution of sweating, prior operation type, reoperation interval, and same-day lumbar sympathectomy failed to gain statistical significance on maintaining persistent resolution of compensatory hyperhidrosis. No patients experienced surgery-related side effects. Thermographic images obtained before/after surgery in 10 patients showed successful denervation and sweat diminishment.This study shows the safeness and effectiveness of DS for treating compensatory hyperhidrosis, representing a new treatment option. Future research should be directed at confirming a promising result of extended DS with further follow-up.
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Chang TNJ, Chen LWY, Lee CP, Chang KH, Chuang DCC, Chao YK. Microsurgical robotic suturing of sural nerve graft for sympathetic nerve reconstruction: a technical feasibility study. J Thorac Dis 2020; 12:97-104. [PMID: 32190359 DOI: 10.21037/jtd.2019.08.52] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Endoscopic thoracic sympathectomy (ETS) may provide a permanent surgical cure for primary palmar hyperhidrosis. Unfortunately, some patients can experience intensive post-operative compensatory sweating (CS) that ultimately impairs quality of life. Sympathetic nerve reconstruction (SNR) may be used to counteract severe post-operative CS through the restoration of sympathetic pathways. In this case series, we describe the technical feasibility of a robot-assisted micro-peripheral nerve reconstruction method for achieving SNR in patients with post-operative CS. Methods Between January 2017 and May 2019, seven cases with severe post-operative CS underwent robot-assisted SNR using a sural nerve graft. We report the pre-operative assessment, the surgical technique, and the clinical outcomes of the study patients. Results The study sample consisted of five men and two women (median age: 41 years). Primary hyperhidrosis affected the face in one case and the palms in six patients. The median time between ETS and SNR was 20 years. All robotic surgery procedures were successfully accomplished, and neither conversion to open surgery nor the creation of additional ports were required. Sural nerve grafts (median length: 8 cm) were used in all cases, and the median operating time was 10.5 h. There was no operative mortality, with the median length of post-operative hospital stay being 4 days. One patient developed a post-operative pneumothorax-which was treated conservatively. Conclusions Our case series demonstrates the safety and clinical feasibility of microsurgical robot-assisted sural nerve grafting for achieving SNR in patients with post-operative CS.
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Affiliation(s)
- Tommy Nai-Jen Chang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan
| | - Lisa Wen-Yu Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan
| | - Chin-Pang Lee
- Department of Psychiatry, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan
| | - Kuo-Hsuan Chang
- Department of Neurology, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan
| | - David Chwei-Chin Chuang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan
| | - Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan
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Vanaclocha V, Sáiz Sapena N, Rivera M, Herrera JM, Ortiz-Criado JM, Monzó-Blasco A, Guijarro-Jorge R, Vanaclocha L. Selective block of grey communicantes in upper thoracic sympathectomy. A feasibility study on human cadaveric specimens. Br J Neurosurg 2019; 34:362-369. [PMID: 31353968 DOI: 10.1080/02688697.2019.1645297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Sympathetic chain interruption is the gold standard treatment for essential hyperhidrosis. Postoperative compensatory hyperhidrosis, the main reason for patients' dissatisfaction, is reduced by selectively lesioning white and grey rami communicantes (ramicotomy).Objective: To develop an endoscopic surgical technique that interrupts only T3 and T4 grey rami communicantes to minimize compensatory hyperhidrosis.Material and Methods: T3 and T4 grey rami communicantes ramicotomy in fifteen cold-preserved cadavers through a uniportal axillary endoscopic approach. The sympathetic chain, its ganglia, and white rami communicantes were left intact. On opening the chest, the sympathetic chain, rami communicantes and ganglia were dissected, photographed, measured and excised for histological examination.Results: Dissecting the grey rami communicantes is feasible as they consistently lie between the intercostal nerve and the homonymous sympathetic ganglion. At some levels, Kuntz nerves, as well as more than one grey ramus communicans, can be found. White rami communicantes are more medial, therefore damaging them can be avoided. Intercostal veins can be obstructive, but these can be controlled via coagulation or clipping if necessary.Conclusion: Uniportal endoscopic selective excision of the T3 and T4 grey rami communicantes is feasible without damaging the white rami communicantes, the sympathetic chain or its ganglia. Clipping the grey rami communicantes is technically possible but not reliable due to their thin diameter. This study confirms that T3 and T4 grey rami sympathetic block is technically feasible. Its application might reduce compensatory hyperhidrosis, but clinical studies are needed.
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Affiliation(s)
- Vicente Vanaclocha
- Department of Neurosurgery, Hospital General Universitario de Valencia, Valencia, Spain
| | - Nieves Sáiz Sapena
- Department of Anesthesiology, Hospital 9 de Octubre de Valencia, Valencia, Spain
| | - Marlon Rivera
- Department of Neurosurgery, Hospital General Universitario de Valencia, Valencia, Spain
| | - Juan Manuel Herrera
- Department of Neurosurgery, Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | - Ricardo Guijarro-Jorge
- Department of Thoracic Surgery, Hospital General Universitario de Valencia, Valencia, Spain
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Hajjar WM, Al-Nassar SA, Al-Sharif HM, Al-Olayet DM, Al-Otiebi WS, Al-Huqayl AA, Hajjar AW. The quality of life and satisfaction rate of patients with upper limb hyperhidrosis before and after bilateral endoscopic thoracic sympathectomy. Saudi J Anaesth 2019; 13:16-22. [PMID: 30692883 PMCID: PMC6329233 DOI: 10.4103/sja.sja_335_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Hyperhidrosis is a functional disorder identified by excessive sweating. Its incidence is approximately 1% in any population. Bilateral endoscopic thoracic sympathectomy (BETS) intervention is the definitive treatment of choice for palmar and axillary hyperhidrosis. Aims and Objectives: The purpose of this study is to evaluate and compare the quality of life (QOL) and satisfaction rate of patients with upper limb hyperhidrosis before and after BETS surgery and the influence of compensatory hyperhidrosis (CH) on patients’ QOL after surgery. Settings and Design: This study is a cross-sectional study designed to generate longitudinal data. Subjects and Methods: This study is a cross-sectional study designed to generate longitudinal data pre- and postbilateral BETS prospectively. This study was conducted in the surgery department of University Hospital in Riyadh, Saudi Arabia. Hundred patients with upper limb hyperhidrosis who underwent BETS from 2014 to 2017 were included. A modified and validated QOL questionnaire for hyperhidrosis was completed by the patients themselves in order to compare the QOL for patients both before and after BETS. Patients’ satisfaction and the occurrence of CH were obtained postoperatively. Statistical Analysis Used: Data were analyzed using the SPSS® statistical package for social studies, version 22.0 (SPSS 22; IBM Corp., New York, NY, USA) for Windows®. Results: A total of 100 patients completed the questionnaire; 94% of patients had a positive QOL outcome after the surgery. The mean decrease in QOL scores was −42.0 points toward better QOL. The site of sweating had a significant effect on the patients’ QOL before and after the surgery (P value < 0.001). Moreover, 76% of patients reported a high satisfaction rate. Conclusion: Primary hyperhidrosis can negatively impair patients’ QOL in different domains. BETS showed to be an effective option for improving the QOL of patients and it provided both short- and long-term effectiveness in treating upper limb hyperhidrosis. CH did not interfere with the rate of patient satisfaction or their QOL postoperatively.
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Affiliation(s)
- Waseem M Hajjar
- Department of Surgery, Thoracic Surgery Division, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Sami A Al-Nassar
- Department of Surgery, Thoracic Surgery Division, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Heba M Al-Sharif
- Department of Surgery, Thoracic Surgery Division, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Dana M Al-Olayet
- Department of Surgery, Thoracic Surgery Division, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Wejdan S Al-Otiebi
- Department of Surgery, Thoracic Surgery Division, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Alanoud A Al-Huqayl
- Department of Surgery, Thoracic Surgery Division, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Adnan W Hajjar
- Department of Surgery, Thoracic Surgery Division, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
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Kara M, Kose S, Cayirci CE, Koksal A. Can we predict the compensatory hyperhidrosis following a thoracic sympathectomy? Indian J Thorac Cardiovasc Surg 2018; 35:190-195. [PMID: 33061004 DOI: 10.1007/s12055-018-0769-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/01/2018] [Accepted: 11/09/2018] [Indexed: 01/25/2023] Open
Abstract
Background Primary hyperhidrosis is a functionally and socially disabling condition resulting in social embarrassment and low quality of life. Thoracic sympathectomy is a definitive choice of treatment with favorable results. However, patients may face another embarrassing condition following surgery as compensatory hyperhidrosis which has no definitive treatment. The predictors of compensatory hyperhidrosis are controversial and remain unclear. Patients and methods A total of 74 patients underwent a videothoracoscopic sympathectomy for primary hyperhidrosis. We statistically analyzed our patients with correlations and uni-multivariate logistic regression models to outline the possible predictors of compensatory hyperhidrosis. Results A total of 45 (60.8%) patients had compensatory hyperhidrosis. The correlations showed that patients, with age greater than 21 years (P = 0.018), with body mass index (BMI) greater than 22 kg / m2 (P = 0.045), with isolated facial hyperhidrosis (P = 0.044), and with smoking status (P = 0.015), had significantly greater rates of compensatory hyperhidrosis. Similarly, the significant univariate predictors of compensatory hyperhidrosis were age > 21 (P = 0.020), BMI > 22 kg / m2 (P = 0.048), and the presence of smoking status (P = 0.015). Multivariate analysis revealed only smoking as a predictor within the threshold of significance (P = 0.078). Conclusion The clinical predictors of compensatory hyperhidrosis following a thoracic sympathectomy appear as older age, greater body mass index, and smoking.
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Affiliation(s)
- Murat Kara
- Department of Thoracic Surgery, Istanbul University School of Medicine, Istanbul, Turkey
| | - Selcuk Kose
- Department of Thoracic Surgery, Bakirkoy Research and Training Hospital, Istanbul, Turkey
| | | | - Ayhan Koksal
- Department of Neurology, Bakirkoy Research and Training Hospital, Istanbul, Turkey
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Lima SO, Aragão JFB, Machado Neto J, de Almeida KBS, Menezes LMS, Santana VR. Research of primary hyperhidrosis in students of medicine of the State of Sergipe, Brazil. An Bras Dermatol 2015; 90:661-5. [PMID: 26560211 PMCID: PMC4631231 DOI: 10.1590/abd1806-4841.20153859] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 11/12/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Hyperhidrosis or excessive sweat production occurs at 2.9-9% of the population. OBJECTIVE To estimate the prevalence and disorders due to primary hyperhidrosis (HP) in medicine students in the state of Sergipe. METHODS Cross-sectional study using individual interviews. RESULTS Hyperhidrosis was found in 14.76% of subjects, the most affected regions were palmar, plantar and axillary, causing prejudice in daily activities. Family history occurred in 45% and 22.72% was diagnosed by a physician. CONCLUSION The prevalence of hyperhidrosis in medicine students of Sergipe was high, with strong family and a small portion of diagnoses made by medical professionals.
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Affiliation(s)
- Sônia Oliveira Lima
- Universidade Tiradentes (UNIT) – Aracaju (SE),
Brazil
- Universidade Federal de Sergipe (UFS) – Aracaju (SE),
Brazil
| | | | | | | | | | - Vanessa Rocha Santana
- Universidade Tiradentes (UNIT) – Aracaju (SE),
Brazil
- Secretaria Municipal de Saúde de Itabaiana – Itabaiana
(SE), Brazil
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Jeong JY, Park SS, Sim SB, Jo KH, Lee J, Oh S, Shin JS. Prediction of compensatory hyperhidrosis with botulinum toxin A and local anesthetic. Clin Auton Res 2015; 25:201-5. [PMID: 25952006 DOI: 10.1007/s10286-015-0288-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 02/09/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Compensatory hyperhidrosis (CH) is one of the most problematic complications of sympathectomy, which occurs often and is hard to treat. A predictive procedure (PP) for CH can help patients experience compensatory sweating before sympathectomy to determine whether or not to perform sympathectomy. Our study aimed to evaluate the CH after the PP and sympathectomy in patients with primary palmar hyperhidrosis using multiple drugs. METHODS We reviewed 83 patients who underwent a PP between July 2009 and August 2013 with primary palmar hyperhidrosis. In group A, we used levobupivacaine (n = 39). In group B, we used botulinum toxin A plus ropivacaine for the PP in group B (n = 44). RESULTS The CH rate after the PP was 44 % (group A) and 25 % (group B), and after sympathectomy 80 % (group A) and 75 % (group B). The prediction value between the PP and the sympathectomy was statistically significant in group A (p < 0.05). The positive prediction rate was 73 % and the negative prediction rate was 27 % in group A. CONCLUSIONS Local anesthetic alone has a better predictive value. From our finding, patients should be made aware that CH after sympathectomy is less severe in 73 % of cases than that experienced in the PP.
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Affiliation(s)
- Jin Yong Jeong
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - Soo Seog Park
- Department of Anesthesiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - Sung Bo Sim
- Department of Thoracic and Cardiovascular Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - Keon Hyon Jo
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - Jongho Lee
- Department of Thoracic and Cardiovascular surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea.
| | - Saecheol Oh
- Department of Anesthesiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - Jae Seong Shin
- Department of Thoracic and Cardiovascular Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
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Paliogiannis P, Marrosu A, Attene F, Trignano M, Scognamillo F. An unusual case of excessive sweating affecting the right upper limb after bilateral endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: recurrence or compensatory hyperhidrosis? Eur Surg 2014. [DOI: 10.1007/s10353-014-0275-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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