Thorac Cardiovasc Surg 2015; 63(08): 723-726
DOI: 10.1055/s-0034-1397041
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Unilateral Sympathectomy for Primary Palmar Hyperhidrosis

Hassan Ravari
1   Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Islamic Republic of Iran
,
Ataollah Rajabnejad
1   Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Islamic Republic of Iran
› Author Affiliations
Further Information

Publication History

04 September 2014

10 November 2014

Publication Date:
20 January 2015 (online)

Abstract

Background and Objective Primary palmar hyperhidrosis that arises mostly during puberty and early adolescence has a tremendous impact on the quality of life in patients. This study aimed to investigate the effectiveness of unilateral video-assisted thoracic sympathectomy for dominant hand in these patients.

Patients and Methods From July 2010 to June 2013, 52 patients with primary palmar hyperhidrosis underwent unilateral video-assisted thoracoscopic sympathectomy for dominant hand. We analyzed the outcomes regarding the resolution of symptoms, occurrence of complications, recurrence rate, and compensatory hyperhidrosis, and need of operation for opposite side.

Findings All patients were followed up from 6 to 42 months. Palmar hyperhidrosis was completely alleviated and absolute dryness was achieved in all patients at the same hand after the operation. Palmar hyperhidrosis in the opposite hand was cured to a complete dryness in 24 (46.15%) patients. No change happened in the opposite hand in 22 (42.3%) patients, but an increase was seen in 6 (11.53%) patients. Only seven (13.46%) patients needed to undergo contralateral sympathectomy. Compensatory hyperhidrosis occurred in 13 patients (25%) after unilateral sympathectomy. Another five patients (totally 18, 34.6%) were involved with compensatory hyperhidrosis after contralateral sympathectomy. It was mainly on the trunk in all 18 patients.

Conclusion Unilateral dominant side thoracoscopic sympathectomy for patients with primary palmar hyperhidrosis is an effective, safe, and minimally invasive procedure. Only a small number of patients will eventually require a contralateral sympathectomy in nondominant hand.

 
  • References

  • 1 Connolly M, de Berker D. Management of primary hyperhidrosis: a summary of the different treatment modalities. Am J Clin Dermatol 2003; 4 (10) 681-697
  • 2 White JW. Treatment of primary hyperhidrosis. Mayo Clinic Proc 1986; 61 (12) 951-956
  • 3 Walling HW, Swick BL. Treatment options for hyperhidrosis. Am J Clin Dermatol 2011; 12 (5) 285-295
  • 4 Li X, Chen R, Tu YR , et al. Epidemiological survey of primary palmar hyperhidrosis in adolescents. Chin Med J (Engl) 2007; 120 (24) 2215-2217
  • 5 Stolman LP. Treatment of hyperhidrosis. Dermatol Clin 1998; 16 (4) 863-869
  • 6 Baumgartner FJ, Toh Y. Severe hyperhidrosis: clinical features and current thoracoscopic surgical management. Ann Thorac Surg 2003; 76 (6) 1878-1883
  • 7 Ro KM, Cantor RM, Lange KL, Ahn SS. Palmar hyperhidrosis: evidence of genetic transmission. J Vasc Surg 2002; 35 (2) 382-386
  • 8 Amir M, Arish A, Weinstein Y, Pfeffer M, Levy Y. Impairment in quality of life among patients seeking surgery for hyperhidrosis (excessive sweating): preliminary results. Isr J Psychiatry Relat Sci 2000; 37 (1) 25-31
  • 9 Schneier FR, Heimberg RG, Liebowitz MR, Blanco C, Gorenstein LA. Social anxiety and functional impairment in patients seeking surgical evaluation for hyperhidrosis. Compr Psychiatry 2012; 53 (8) 1181-1186
  • 10 Streker M, Kerscher M. Antiperspirants for the therapy of focal hyperhidrosis [in German]. Hautarzt 2012; 63 (6) 452-455
  • 11 Naumann M, Hofmann U, Bergmann I, Hamm H, Toyka KV, Reiners K. Focal hyperhidrosis: effective treatment with intracutaneous botulinum toxin. Arch Dermatol 1998; 134 (3) 301-304
  • 12 Ambrogi V, Campione E, Mineo D, Paternò EJ, Pompeo E, Mineo TC. Bilateral thoracoscopic T2 to T3 sympathectomy versus botulinum injection in palmar hyperhidrosis. Ann Thorac Surg 2009; 88 (1) 238-245
  • 13 Ibrahim M, Menna C, Andreetti C , et al. Two-stage unilateral versus one-stage bilateral single-port sympathectomy for palmar and axillary hyperhidrosis. Interact Cardiovasc Thorac Surg 2013; 16 (6) 834-838
  • 14 Chen Y-B, Ye W, Yang WT , et al. Uniportal versus biportal video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis. Chin Med J (Engl) 2009; 122 (13) 1525-1528
  • 15 Georghiou GP, Berman M, Bobovnikov V, Vidne BA, Saute M. Minimally invasive thoracoscopic sympathectomy for palmar hyperhidrosis via a transaxillary single-port approach. Interact Cardiovasc Thorac Surg 2004; 3 (3) 437-441
  • 16 Scheer F , et al. Clinical importance of CT-assisted sympathicolysis in primary, focal plantar and palmar hyperhidrosis [in German]. RoFo 2012; 184 (7) 624-628
  • 17 Unal O, Citgez B, Battal M, Karatepe O. Single incision thoracoscopic sympathectomy for hyperhidrosis. BMJ Case Rep 2012; 2012: 0120125692
  • 18 Ng CSH, Yeung ECL, Wong RHL, Wan IYP, Chui P-T, Underwood MJ. Bilateral single-port video-assisted thoracic surgery sympathectomy for palmar hyperhidrosis with VasoView® device. Surgical Practice 2012; 16 (1) 42-43
  • 19 Fiorelli A, D'Aponte A, Canonico R , et al. T2-T3 sympathectomy versus sympathicotomy for essential palmar hyperhidrosis: comparison of effects on cardio-respiratory function. Eur J Cardiothorac Surg 2012; 42 (3) 454-461
  • 20 Ibrahim M, Menna C, Andreetti C , et al. Bilateral single-port sympathectomy: long-term results and quality of life. Biomed Res Int 2013; 2013: 348017
  • 21 Lin M, Tu YR, Lai FC , et al. Transaxillary concealing single incision endoscopic thoracic sympathectomy in the treatment of palmar hyperhidrosis: a novel surgical approach [IN Chinese]. Zhonghua Yi Xue Za Zhi 2013; 93 (41) 3300-3301
  • 22 Al Dohayan A. Transaxillary thoracoscopic sympathectomy experience in a hot climate: management of the dominant hand. Surg Laparosc Endosc Percutan Tech 1999; 9 (5) 317-321
  • 23 Wali MA. Early experience with thoracoscopic sympathectomy for palmar hyperhidrosis. Ann Thorac Cardiovasc Surg 2003; 9 (6) 351-354
  • 24 Stefaniak TJ, Dobosz Ł, Kaczor M, Ćwigoń M. Diagnosis and treatment of primary hyperhidrosis. Pol Przegl Chir 2013; 85 (9) 527-543
  • 25 Singh B, Moodley J, Allopi L, Cassimjee HM. Horner syndrome after sympathectomy in the thoracoscopic era. Surg Laparosc Endosc Percutan Tech 2006; 16 (4) 222-225
  • 26 Adar R. Surgical treatment of palmar hyperhidrosis before thoracoscopy: experience with 475 patients. Eur J Surg Suppl 1994; (572) 9-11
  • 27 Wolosker N, Yazbek G, Milanez de Campos JR, Kauffman P, Ishy A, Puech-Leão P. Evaluation of plantar hyperhidrosis in patients undergoing video-assisted thoracoscopic sympathectomy. Clin Auton Res 2007; 17 (3) 172-176