A comparative study of thoracoscopic sympathectomy for the treatment of hand sweating

Comparing Compensatory Sweating After Video-Assisted Thoracoscopic Sympathectomy: (T2-3) Versus (T2-4) Levels for Treating Palmar Hyperhidrosis

INTRODUCTION

Primary hyperhidrosis is a disease that is characterized by excessive sweating beyond what is required to maintain the normal temperature of the body. Moreover, it has a great adverse effect on the life of the affected persons because of problems in their social lives. There are different modalities to treat primary hyperhidrosis, including medical and surgical treatment. However, in sympathectomy, there is still a lack of strong evidence regarding which level should be targeted to achieve maximum benefit with fewer complications.

METHODS

This prospective clinical study was conducted at the Cardiothoracic Surgery Department, Alexandria Main University Hospital, Alexandria, Egypt, from September 2021 to Jan 2022. The study involved a total of 50 eligible consecutive patients who had bilateral primary palmar hyperhidrosis managed by bilateral, bi-portal, and tubeless thoracoscopic approach with conventional general anesthesia. Group A represents 25 patients with 13 males (52%) who had sympathetic chain cutting at the level of T2-3, and group B represents 25 patients with 15 males (60%) who had sympathetic chain cutting at the level of T2-4. The effect on palmar hyperhidrosis, compensatory hyperhidrosis, and overall patient satisfaction was assessed on the Visual Analog Scale (VAS).

RESULT

Ninety-eight percent of patients in both groups showed postoperative complete dryness of the hand and improvement of their symptoms. There was a statistically significant (p<0.001) difference regarding the degree of severity of compensatory sweating post-operatively between both groups. In group A, 44% of patients had compensatory sweating, while in group B, 96% of patients had symptoms of compensatory sweating with varying degrees from 1 to 5 on a VAS-Score of five degrees.

CONCLUSION

The level of cauterization has no significant effect on palmar hyperhidrosis dryness after cutting the sympathetic chain at level (T2-3) vs. (T2-4). However, the greater the number of levels that are cauterized, which are three levels rather than two, the more severe the compensatory sweating in this study.

Comparing the effectiveness of single-lumen high-frequency positive pressure ventilation with double-lumen endobronchial tube for the anesthesia management of endoscopic thoracic sympathetic blockade surgery

OBJECTIVES

In this trial, we aimed to compare anesthetic effectiveness of single lumen tube (SLT) for tracheal intubation with high-frequency positive pressure ventilation (HFPPV) versus classic double lumen tube (DLT) for tracheal intubation in endoscopic thoracic sympathetic blockade surgery.

DESIGN

This was a prospective randomized controlled clinical study.

SETTING

The study was single-centered and conducted in a university hospital.

PARTICIPANTS

There were 135 endoscopic thoracic sympathetic blockade patients in this study.

INTERVENTIONS

The patients were randomly allocated either to DLT (n = 67) or SLT (n = 68) groups. In SLT group, the ventilator setting was kept with frequencies that range from 1 to 1.8 Hz (60-110/min). Data regarding anesthesia duration, surgery duration, difficult intraoperative lung deflation, postoperative atelectasis, postoperative pain, postoperative pneumothorax were recorded and compared. All patients were operated by a single experienced surgeon under general anesthesia provided by the same anesthesia team.

MEASUREMENTS AND MAIN RESULTS

Both groups were age and gender matched. Among all recorded variables, only anesthesia time was found to be close to statistical significance (P = .059, favoring single lumen). All other parameters were found to be similar between groups. (P < .05).

CONCLUSION

We reported that DLT and single lumen tracheal intubation were equally effective for lung deflation during surgery, and SLT with HFPPV ventilation mode during endoscopic thoracic sympathetic blockade surgery provided the surgeon with an adequate and clean workspace with shorter onset of anesthesia. We may suggest the HFPPV technique for uncomplicated surgery groups or where sufficient conditions for DLT cannot be provided in the operating room.

Retroperitoneoscopic lumbar sympathectomy for the treatment of primary plantar hyperhidrosis

Background

Primary plantar hyperhidrosis (PPH) is an idiopathic disease, characterized by excessive sweating of the feet. It leads to significant disturbance in private and professional daily lifestyle, due to excessive sweating. The aim of this study is to present the safety, efficacy and procedures of retroperitoneoscopic lumbar sympathectomy (RLS) for treatment of PPH.

Methods

RLS was performed 60 times in 30 patients (18 men, 12 women) with PPH in our institution from May 2019 to October 2020. All procedures were carried out by laparoscopy with retroperitoneal approach. Clinical data including patient demographics and perioperative, postoperative outcomes were evaluated. Recurrence of symptoms, and any adverse effects of surgery were evaluated after 7 to 30 days in outpatient clinic, and thereafter every 6 months.

Results

Mean age of patients was 33.6 (± standard deviation 10.8) years. Fourteen and fifteen patients were previously treated with medical therapy or endoscopic thoracic sympathectomy (ETS) respectively. Mean preoperative quality of life (QoL) score of patients was 91.8 (VERY BAD), but postoperative 12 months (QoL) score decreased to 29.1 (MUCH BETTER). There was no serious postoperative complication. During the mean 22 months of follow-up period, no compensatory sweating was observed.

Conclusions

RLS can be a safe and effective surgical treatment for severe PPH, especially for the patients with persistent plantar sweating even after conservative management and ETS. RLS also could be offered to surgeons who are familiar with retroperitoneal space anatomy as feasible surgical treatment for PPH.

Symptoms of anxiety and depression in patients with primary hyperhidrosis and its association with the result of clinical treatment with oxybutynin

OBJECTIVES

Studies have identified correlations between the psychological characteristics of individuals with primary hyperhidrosis (HH), the degree of sweating, and the quality of life (QoL). This study aimed to evaluate the prevalence of anxiety and depression symptoms in patients with HH before and after oxybutynin treatment.

METHODS

Data were collected from 81 patients. Palmar or axillary HH was the most frequent complaint (84.0%). All patients were evaluated before the medication was prescribed and after five weeks of treatment. The Beck Depression Inventory and Beck Anxiety Inventory were used to evaluate depression and anxiety.

RESULTS

Improvement in HH occurred in 58 patients (71.6%), but there was no improvement in 23 patients (28.4%). The QoL before treatment in all patients was either "poor" or "very poor." Patients who experienced improvement in sweating rates also experienced a greater improvement in QoL than patients who did not experience improvement in sweating at the main site (87.9% vs. 34.7%) (p<0.001). A total of 19.7% of patients showed an improvement in their level of depression, and a total of 46.9% of patients exhibited improvements in their level of anxiety. A significant correlation was observed between sweating and anxiety (p=0.015).

CONCLUSION

Patients with HH who experienced improvements in sweating immediately after treatment with oxybutynin exhibited small improvements in their levels of depression and significant improvements in their levels of anxiety and QoL.