Does the Sweating Severity of Primary Hyperhidrosis Sites Affect Post-Sympathotomy Results?
Background Improvement in quality of life (QOL) and patient satisfaction after endoscopic thoracic sympathotomy (ETS) in patients with primary hyperhidrosis may be affected by various factors. We examined whether the preoperative sweating severity of primary hyperhidrosis sites affects postoperative results.
Methods The records of 112 patients who underwent bilateral ETS were reviewed retrospectively. The patients were divided into three groups according to the sweating severity score obtained from all primary hyperhidrosis sites (primary hyperhidrosis severity score [PHSS]) and analyzed comparatively. Group A (PHSS = 1–4) included 22 patients, Group B (PHSS = 5–8) 36 patients, and Group C (PHSS ≥ 9) 54 patients. Outcome measures included QOL prior to surgery, improvement in QOL after surgery, degree of clinical improvement, presence, severity, localization, and site number of reflex sweating (RS) and general patient satisfaction after 6 months of surgery.
Results The preoperative QOL of patients with higher PHSS (groups B, C) was worse than other patients (group A). More than 91% of all patients had any level improvement in QOL, and over 96% had slight or great clinical improvement. RS developed in 80% of the patients, mostly in the back, very severe in 8%, and in median two different body areas. The overall patient satisfaction rate was more than 95%. There was no significant difference between the three groups in terms of all postoperative results.
Conclusion Preoperative sweating severity of primary hyperhidrosis sites does not affect post-sympathotomy results. Surgeons should not be worried when deciding upon surgery, even in patients with high sweating severity.
Keywordsthoracoscopic sympathotomy - hyperhidrosis - nerve - quality of life - primary hyperhidrosis - reflex sweating
Received: 25 May 2020
Accepted: 29 July 2020
24 December 2020 (online)
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- 1 Walling HW. Clinical differentiation of primary from secondary hyperhidrosis. J Am Acad Dermatol 2011; 64 (04) 690-695
- 2 Teivelis MP, Varella AY, Wolosker N. Expanded level of sympathectomy and incidence or severity of compensatory hyperhidrosis. J Thorac Cardiovasc Surg 2014; 148 (05) 2443-2444
- 3 Estevan FA, Wolosker MB, Wolosker N, Puech-Leão P. Epidemiologic analysis of prevalence of the hyperhidrosis. An Bras Dermatol 2017; 92 (05) 630-634
- 4 Baroncello JB, Baroncello LR, Schneider EG, Martins GG. Evaluation of quality of life before and after videothoracoscopic simpathectomy for primary hyperhidrosis. Rev Col Bras Cir 2014; 41 (05) 325-330
- 5 Sakiyama BY, Monteiro TV, Ishy A, Campos JR, Kauffman P, Wolosker N. Quantitative assessment of the intensity of palmar and plantar sweating in patients with primary palmoplantar hyperhidrosis. J Bras Pneumol 2012; 38 (05) 573-578
- 6 de Campos JR, Kauffman P, Werebe EdeC. et al. Quality of life, before and after thoracic sympathectomy: report on 378 operated patients. Ann Thorac Surg 2003; 76 (03) 886-891
- 7 de Campos JR, Wolosker N, Takeda FR. et al. The body mass index and level of resection: predictive factors for compensatory sweating after sympathectomy. Clin Auton Res 2005; 15 (02) 116-120
- 8 Neves S, Uchoa PC, Wolosker N. et al. Long-term comparison of video-assisted thoracic sympathectomy and clinical observation for the treatment of palmar hyperhidrosis in children younger than 14. Pediatr Dermatol 2012; 29 (05) 575-579
- 9 Wolosker N, Munia MA, Kauffman P, Campos JR, Yazbek G, Puech-Leão P. Is gender a predictive factor for satisfaction among patients undergoing sympathectomy to treat palmar hyperhidrosis?. Clinics (São Paulo) 2010; 65 (06) 583-586
- 10 Wolosker N, Yazbek G, de Campos JR. et al. Quality of life before surgery is a predictive factor for satisfaction among patients undergoing sympathectomy to treat hyperhidrosis. J Vasc Surg 2010; 51 (05) 1190-1194
- 11 Ong W, Lee A, Tan WB, Lomanto D. Long-term results of a randomized controlled trial of T2 versus T2-T3 ablation in endoscopic thoracic sympathectomy for palmar hyperhidrosis. Surg Endosc 2016; 30 (03) 1219-1225
- 12 Wolosker N, Leiderman DBD, de Campos JRM. et al. Number of preoperative hyperhidrosis sites does not affect the sympathectomy postoperative results and compensatory hyperhidrosis occurrence. Thorac Cardiovasc Surg 2019; 67 (05) 407-414
- 13 Esme H, Duran FM. The risk factors of compensatory sweating in patients who have undergone one-stage bilateral single-port thoracoscopic sympathectomy for hyperhidrosis. Ann Clin Anal Med. 2019; 10 (05) 532-536 DOI: 10.4328/ACAM.5991.
- 14 Hornberger J, Grimes K, Naumann M. et al. Multi-Specialty Working Group on the Recognition, Diagnosis, and Treatment of Primary Focal Hyperhidrosis. Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol 2004; 51 (02) 274-286
- 15 de Campos JRM, Kauffman P, Werebe EC. Questionnaire of quality of life in patients with primary hyperhidrosis. J Bras Pneumol 2003; 29: 178-181
- 16 Varella AYM, Fukuda JM, Teivelis MP. et al. Translation and validation of Hyperhidrosis Disease Severity Scale. Rev Assoc Med Bras (1992) 2016; 62 (09) 843-847
- 17 Wolosker N, de Campos JR, Kauffman P, de Oliveira LA, Munia MA, Jatene FB. Evaluation of quality of life over time among 453 patients with hyperhidrosis submitted to endoscopic thoracic sympathectomy. J Vasc Surg 2012; 55 (01) 154-156
- 18 Solish N, Bertucci V, Dansereau A. et al. Canadian Hyperhidrosis Advisory Committee. A comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: recommendations of the Canadian Hyperhidrosis Advisory Committee. Dermatol Surg 2007; 33 (08) 908-923
- 19 Rodríguez PM, Freixinet JL, 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 (03) 514-519
- 20 Karaçam V, Şanlı A, Tertemiz KC, Tasdöğen A. The effect of micro-invasive endoscopic thoracic sympathectomy in palmar hyperhidrosis patients on quality of life and hyperhidrosis. Turk Gogus Kalp Dama. 2017; 25 (04) 638-643
- 21 Cerfolio RJ, De Campos JR, Bryant AS. et al. The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg 2011; 91 (05) 1642-1648
- 22 Glaser DA, Ballard AM, Hunt NL, Pieretti LJ, Pariser DM. Prevalence of multifocal primary hyperhidrosis and symptom severity over time: results of a targeted survey. Dermatol Surg 2016; 42 (12) 1347-1353
- 23 Kara M, Kose S, Cayirci CE, Koksal A. Can we predict the compensatory hyperhidrosis following a thoracic sympathectomy?. Indian J Thorac Cardiovasc Surg. 2019; 35: 190-195
- 24 Lee SS, Lee YU, Lee JH, Lee JC. Comparison of the long-term results of R3 and R4 sympathecotomy for palmar hyperhidrosis. Korean J Thorac Cardiovasc Surg 2017; 50 (03) 197-201
- 25 Vannucci F, Araújo JA. Thoracic sympathectomy for hyperhidrosis: from surgical indications to clinical results. J Thorac Dis 2017; 9 (Suppl. 03) S178-S192
- 26 Schmidt J, Bechara FG, Altmeyer P, Zirngibl H. Endoscopic thoracic sympathectomy for severe hyperhidrosis: impact of restrictive denervation on compensatory sweating. Ann Thorac Surg 2006; 81 (03) 1048-1055
- 27 Licht PB, Pilegaard HK. Severity of compensatory sweating after thoracoscopic sympathectomy. Ann Thorac Surg 2004; 78 (02) 427-431
- 28 Kao MC, Lin JY, Chen YL, Hsieh CS, Cheng LC, Huang SJ. Minimally invasive surgery: video endoscopic thoracic sympathectomy for palmar hyperhidrosis. Ann Acad Med Singapore 1996; 25 (05) 673-678
- 29 Gossot D, Galetta D, Pascal A. et al. Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis. Ann Thorac Surg 2003; 75 (04) 1075-1079
- 30 Yano M, Kiriyama M, Fukai I. et al. Endoscopic thoracic sympathectomy for palmar hyperhidrosis: efficacy of T2 and T3 ganglion resection. Surgery 2005; 138 (01) 40-45
- 31 Lau WT, Lee JD, Dang CR, Lee L. Improvement in quality of life after bilateral transthoracic endoscopic sympathectomy for palmar hyperhydrosis. Hawaii Med J 2001; 60 (05) 126-137 , 137
- 32 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 (01) 152-156
- 33 Miller DL, Bryant AS, Force SD, Miller Jr JI. Effect of sympathectomy level on the incidence of compensatory hyperhidrosis after sympathectomy for palmar hyperhidrosis. J Thorac Cardiovasc Surg 2009; 138 (03) 581-585
- 34 Bryant AS, Cerfolio RJ. Satisfaction and compensatory hyperhidrosis rates 5 years and longer after video-assisted thoracoscopic sympathotomy for hyperhidrosis. J Thorac Cardiovasc Surg 2014; 147 (04) 1160-1163.e1
- 35 Lin CC, Telaranta T. Lin-Telaranta classification: the importance of different procedures for different indications in sympathetic surgery. Ann Chir Gynaecol 2001; 90 (03) 161-166
- 36 Chou SH, Kao EL, Lin CC, Chang YT, Huang MF. The importance of classification in sympathetic surgery and a proposed mechanism for compensatory hyperhidrosis: experience with 464 cases. Surg Endosc 2006; 20 (11) 1749-1753
- 37 Munia MA, Wolosker N, Kauffman P, de Campos JR, Puech-Leão P. A randomized trial of T3-T4 versus T4 sympathectomy for isolated axillary hyperhidrosis. J Vasc Surg 2007; 45 (01) 130-133
- 38 Araújo CAA, Azevedo ÍM, Ferreira MAF, Ferreira HPC, Dantas JLCM, Medeiros AC. Compensatory sweating after thoracoscopic sympathectomy: characteristics, prevalence and influence on patient satisfaction. J Bras Pneumol 2009; 35 (03) 213-220
- 39 Larson DL. Definitive diagnosis and management of axillary hyperhidrosis: the VapoMeter and suction-assisted arthroscopic shaving. Aesthet Surg J 2011; 31 (05) 552-559