Predictive Procedure for Compensatory Hyperhidrosis before Sympathectomy: Preliminary Findings

Abstract

Objective Compensatory hyperhidrosis is one of the most common and serious adverse effects following sympathectomy. We performed a local anesthetic procedure that predicts the occurrence and severity of compensatory hyperhidrosis, and evaluated the feasibility, safety, and efficacy of the procedure.

Methods and Methods From July 2009 to July 2010, 20 patients with severe primary palmar hyperhidrosis underwent predictive procedures. A sympathetic nerve block was obtained via thoracoscopic approach under local anesthesia. The patients were evaluated for compensatory hyperhidrosis 1 week after the procedure before deciding whether to proceed with sympathectomy.

Results Of the 20 patients, 17 patients proceeded with sympathectomy and 3 refused the final procedure. Following sympathectomy, the occurrence and severity of compensatory hyperhidrosis in the remaining 17 patients were statistically analyzed with two tailed paired t test, and there is no significant difference between the predictive and final procedures (t = 1.69, df = 16, p > 0.1).

Conclusion Predictive procedure using local anesthesia to detect compensatory hyperhidrosis before sympathectomy may be useful for helping patients to decide whether to undergo the operation.

Keywords

hyperhidrosis - thoracoscopy/video-assisted thoracoscopic sympathectomy - outcomes (includes mortality, morbidity) - compensatory hyperhidrosis - local anesthesia

• References

• 1 Tetteh HA, Groth SS, Kast T , et al. Primary palmoplantar hyperhidrosis and thoracoscopic sympathectomy: a new objective assessment method. Ann Thorac Surg 2009; 87 (1) 267-274 , discussion 274–275
• 2 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 (3) 514-519
• 3 Dumont P, Denoyer A, Robin P. Long-term results of thoracoscopic sympathectomy for hyperhidrosis. Ann Thorac Surg 2004; 78 (5) 1801-1807
• 4 Weksler B, Blaine G, Souza ZB, 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
• 5 Gossot D, Toledo L, Fritsch S, Célérier M. Thoracoscopic sympathectomy for upper limb hyperhidrosis: looking for the right operation. Ann Thorac Surg 1997; 64 (4) 975-978
• 6 Sugimura H, Spratt EH, Compeau CG, Kattail D, Shargall Y. Thoracoscopic sympathetic clipping for hyperhidrosis: long-term results and reversibility. J Thorac Cardiovasc Surg 2009; 137 (6) 1370-1376 , discussion 1376–1377
• 7 Haam SJ, Park SY, Paik HC, Lee DY. Sympathetic nerve reconstruction for compensatory hyperhidrosis after sympathetic surgery for primary hyperhidrosis. J Korean Med Sci 2010; 25 (4) 597-601
• 8 Jeong JY, Park HJ. Sympathicotomy under local anesthesia: a simple way to treat primary hyperhidrosis. Ann Thorac Surg 2010; 90 (5) 1730-1731
• 9 Telaranta T. Secondary sympathetic chain reconstruction after endoscopic thoracic sympathicotomy. Eur J Surg Suppl 1998; 580 (580) 17-18
• 10 Kim WO, Yoon KB, Kil HK, Yoon DM. Chemical lumbar sympathetic block in the treatment of plantar hyperhidrosis: a study of 69 patients. Dermatol Surg 2008; 34 (10) 1340-1345
• 11 Santosh D, Lakhtakia S, Gupta R , et al. Clinical trial: a randomized trial comparing fluoroscopy guided percutaneous technique vs. endoscopic ultrasound guided technique of coeliac plexus block for treatment of pain in chronic pancreatitis. Aliment Pharmacol Ther 2009; 29 (9) 979-984
• 12 Wang YC, Wei SH, Sun MH, Lin CW. A new mode of percutaneous upper thoracic phenol sympathicolysis: report of 50 cases. Neurosurgery 2001; 49 (3) 628-634 , discussion 634–636
• 13 Lee KS, Chuang CL, Lin CL, Tsai LC, Hwang SL, Howng SL. Percutaneous CT-guided chemical thoracic sympathectomy for patients with palmar hyperhidrosis after transthoracic endoscopic sympathectomy. Surg Neurol 2004; 62 (6) 501-505 , discussion 505
• 14 Elia S, Guggino G, Mineo D, Vanni G, Gatti A, Mineo TC. Awake one stage bilateral thoracoscopic sympathectomy for palmar hyperhidrosis: a safe outpatient procedure. Eur J Cardiothorac Surg 2005; 28 (2) 312-317 , discussion 317
• 15 Miller DL, Force SD. Temporary thoracoscopic sympathetic block for hyperhidrosis. Ann Thorac Surg 2008; 85 (4) 1211-1214 , discussion 1215–1216