Journal Information
Vol. 42. Issue 5.
Pages 230-234 (May 2006)
Share
Share
Download PDF
More article options
Vol. 42. Issue 5.
Pages 230-234 (May 2006)
Original Articles
Full text access
Results of High Bilateral Endoscopic Thoracic Sympathectomy and Sympatholysis in the Treatment of Primary Hyperhidrosis: a Study of 1016 Procedures
Visits
4422
J. Moyaa,b,
Corresponding author
jmoya@ub.edu

Correspondence: Dr. J. Moya. Servicio de Cirugía Torácica. Hospital Universitari de Bellvitge. FeixaLlarga, s/n. 08907 L'Hospitalet de Llobregat. Barcelona. España
, R. Ramosa,b, R. Moreraa, R. Villalongac, V. Pernaa, I. Maciaa, G. Ferrera
a Servicio de Cirugía Torácica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
b Departament de Patologia i Terapèutica Experimental, Facultat de Medicina, Universidad de Barcelona, Barcelona, Spain
c Servicio de Anestesiología y Reanimación, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
This item has received
Article information
Objective

Thoracic sympatholysis and sympathectomy are the current standard treatments for primary hyperhidrosis. In this study, we evaluated the incidence of peri-and postoperative complications associated with these procedures.

Patients and methods

From 1996 to 2004,520 consecutive patients (364 women), with a mean age of 26.8 years, were treated for primary hyperhidrosis at our hospital. The procedure was bilateral in all but 24 cases. The 484 patients in the sympatholysis group underwent a single intervention while the 36 patients in the sympathectomy group underwent 2 separate interventions.

Results

NO deaths occurred. Anhidrosis of the target area was achieved in 97.6% of patients while 2.2% experienced hypohidrosis. In 0.2% of the cases, the procedure was initially unsuccessful and a second intervention was required. The mean duration of hospital stay was 72 hours for patients in the sympathectomy group and 17 hours for the sympatholysis group. Serious intraoperative complications requiring conversion to thoracotomy were recorded in 0.2% of patients. Postoperative complications—of which pneumothorax was the most common—occurred in 5.2% of the cases (in 22.5% of the sympathectomy group and 3.55% of the sympatholysis group). Compensatory hyperhidrosis occurred in 48.4% of the patients, excessive dryness of the hands and palpebral ptosis in 0.38%, and gustatory sweating in 0.9%. The degree of patient satisfaction was quite high (88.5%) and only 2.3% were very unsatisfied.

Conclusions

Given the results obtained, we can conclude that both sympatholysis and sympathectomy are appropriate treatments for hyperhidrosis. Nonetheless, because sympatholysis is both easier to perform and less aggressive, we consider it the treatment of choice for primary hyperhidrosis.

Key words:
Endoscopic thoracic sympathectomy
Hyperhidrosis
Hemothorax
Compensatory hyperhidrosis
Objetivo

La simpaticolisis y la simpatectomía torácica son actualmente los tratamientos habituales de la hiperhidrosis primaria. En este estudio evaluamos la incidencia cuantitativa y cualitativa de las complicaciones peri y postoperatorias.

Pacientes y métodos

Desde 1996 a 2004 se intervino consecutivamente a 520 pacientes (364 mujeres) con hiperhidrosis primaria, con una edad media de 26,8 años. En todos, excepto en 24 casos, el procedimiento fue bilateral. La inter-vención se realizó en un tiempo en 484 pacientes (simpaticólisis) y en 2 tiempos en 36 (simpatectomía).

Resultados

NO hubo mortalidad. La anhidrosis del te-rritorio deseado fue del 97,6 %, se apreció hipohidrosis en el 2,2% y hubo un 0,2% de fallos que requirieron reinterven-ción. La estancia media fue de 72 h en el grupo de simpatectomía y de 17 h en el de simpaticólisis. Se registró un 0,2% de complicaciones intraoperatorias mayores con reconversión a toracotomía. Se produjo un 5,2% de complicaciones postoperatorias (un 22,5% en las simpatectomías y un 3,55% en la simpaticólisis), de las cuales el neumotórax fue la más frecuente. Se observó hiperhidrosis compensadora en un 48,4% de los casos, sequedad excesiva de manos y ptosis palpebral en el 0,38%, e hiperhidrosis gustativa en un 0,9% de casos. El grado de satisfacción fue muy elevado (88,5%) y sólo un 2,3% de los pacientes se manifestaron muy insatisfe-chos.

Conclusiones

De los resultados obtenidos se deduce que tanto la simpaticolisis como la simpatectomía son tratamientos adecuados de la hiperhidrosis, si bien la mayor sencillez y menor agresividad de la primera nos llevan a considerarla el tratamiento de elección en la hiperhidrosis primaria.

Palabras clave:
Simpatectomía torácica endoscópica
Hiperhidrosis
Hemotórax
Hiperhidrosis compensadora
Full text is only aviable in PDF
REFERENCES
[1]
R Ramos, J Moya, J Pérez, R Villalonga, R Morera, R Pujol, et al.
Hiperhidrosis primaria: estudio prospectivo de 338 pacientes.
Med Clin (Barc)., 121 (2003), pp. 201-203
[2]
R Ramos, J Moya, V Turón, J Pérez, R Villalonga, R Morera, et al.
Hiperhidrosis primaria y ansiedad. Estudio prospectivo y preoperatorio de 158 pacientes.
Arch Bronconeumol., 41 (2005), pp. 88-92
[3]
R Wittmoser.
Sympathectomies et vagotomies par thoracoscopie.
Techniques de chirurgie endoscopique du thorax, pp. 168-189
[4]
J Moya, G Ferrer, J Peyrí, R Pujol, R Morera, X Tarrado, et al.
Simpatectomía torácica endoscópica en el tratamiento de la hiperhidrosis palmar primaria. A propósito de 28 casos.
Actas Dermosifiliogr., 91 (2000), pp. 43-46
[5]
J Moya, G Ferrer, R Morera, R Pujol, R Ramos, R Villalonga, et al.
Estudio comparativo entre gangliectomía y la simpaticólisis torácica superior para el tratamiento quirúrgico de la hiperhidrosis palmar primaria. A propósito de 185 procedimientos en 100 pacientes.
Actas Dermosifiliogr., 92 (2001), pp. 369-375
[6]
N Doolabh, S Horswell, M Williams, L Huber, S Prince, DM Meyer, et al.
Thoracoscopic sympathectomy for hyperhidrosis: indications and results.
Ann Thorac Surg., 77 (2004), pp. 410-414
[7]
D Gossot, D Galetta, A Pascal, D Debrosse, R Caliandro, P Girard, et al.
Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis.
Ann Thorac Surg., 75 (2003), pp. 1075-1079
[8]
C Drott, G Göthberg, G Claes.
Endoscopic transthoracic sympathectomy: an efficient and safe method for the treatment of hyperhidrosis.
J Am Acad Dermatol., 33 (1995), pp. 78-81
[9]
AE Cameron.
Complications of endoscopic sympathectomy.
Eur J Surg., 580 (1998), pp. 33-35
[10]
P Dumont, A Denoyer, P Robin.
Long-term results of thoracoscopic sympathectomy for hyperhidrosis.
Ann Thorac Surg., 78 (2004), pp. 1801-1807
[11]
WP Hederman.
Present and future trends in thoracoscopic sympathectomy.
Eur J Surg., 572 (1994), pp. 17-19
[12]
TS Lin, HY Fang.
Transthoracic endoscopic sympathectomy in the treatment of palmar hyperhidrosis with emphasis on perioperative management (1360 case analyses).
Surg Neurol., 52 (1999), pp. 453-457
[13]
CH Neumayer, G Bischof, R Fugger, et al.
Efficacy and safety of thoracoscopic sympathicotomy for hyperhidrosis of the upper limb. Results of 734 sympathicotomies.
Ann Chir Gynaecol., 90 (2001), pp. 195-199
[14]
F Herbst, EG Plas, R Fugger, A Fritsch.
Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs. A critical analysis and long-term results of 480 operations.
Ann Surg., 220 (1994), pp. 86-90
[15]
J Zacherl, ER Huber, M Imhof, EG Plas, F Herbst, R Fugger.
Long-term results of 630 thoracoscopic sympathicotomies for primary hyperhidrosis: the Vienna experience.
Eur J Surg., 580 (1998), pp. 43-46
[16]
D Gossot, H Kabiri, R Caliandro, D Debrosse, P Girard, D Grunenwald.
Early complications of thoracic endoscopic sympathectomy: a prospective study of 940 procedures.
Ann Thorac Surg., 71 (2001), pp. 1116-1119
[17]
YT Lai, LH Yang, CC Chio, HH Chen.
Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy.
Neurosurgery, 41 (1997), pp. 110-113
[18]
W Cheng, C Chang, T Lin.
Chylothorax after endoscopic sympathectomy: case report.
Neurosurgery, 35 (1994), pp. 330-331
[19]
JF Lange.
Inferior brachial plexus injury during thoracoscopic sympathectomy.
Surg Endosc., 9 (1995), pp. 830
[20]
D Lardinois, HB Ris.
Minimally invasive video-endoscopic sympathectomy by use of a transaxillary single port approach.
Eur J Cardiothorac Surg., 21 (2002), pp. 67-70
[21]
CJ Lan, HN Luk, CT Wu, WK Chang, MY Tsou, PW Lui, et al.
Bilateral pulmonary edema after endoscopic sympathectomy in a patient with glucose-6-phosphate dehydrogenase deficiency.
Acta Anaesthesiol Scand., 45 (2001), pp. 123-126
[22]
H Yoon, Y Ha, YG Park, JW Chang.
Thoracoscopic limited T-3 sympathicotomy for primary hyperhidrosis: prevention for compensatory hyperhidrosis.
J Neurosurg., 99 (2003), pp. 39-43
[23]
M Riet, AA Smet, H Kuiken, G Kazemier, HJ Bonjer.
Prevention of compensatory hyperhidrosis after thoracoscopic sympathectomy for hyperhidrosis.
Surg Endosc., 15 (2001), pp. 1159-1162
[24]
G Lesèche, Y Castier, G Thabut, MD Petit, M Combes, O Cerceau, et al.
Endoscopic transthoracic sympathectomy for upper limb hyperhidrosis: limited sympathectomy does not reduce postoperative compensatory sweating.
J Vasc Surg., 37 (2003), pp. 124-128
[25]
CC Lin, LR Mo, SM Lee, SM Ng, MH Hwang.
Thoracoscopic T2-sympathectomy block by clipping: a better and reversible operation for treatment of hyperhidrosis palmaris. Experience in 326 cases.
Eur J Surg., 580 (1998), pp. 13-16
[26]
J Moya, R Ramos, N Vives, J Pérez, R Morera, V Perna, et al.
Sudación compensatoria secundaria a la simpaticólisis superior. Estudio de 123 casos.
Arch Bronconeumol., 40 (2004), pp. 360-363
[27]
JL Yarzebski, HA Wilkinson.
T2 and T3 sympathetic ganglia in the adult human: a cadaver and clinical-radiographic study and its clinical application.
Neurosurgery, 21 (1987), pp. 339-342
[28]
L Ramsaroop, B Singh, J Moodley, P Partab, KS Satyapal.
Anatomical basis for a successful upper limb sympathectomy in the thoracoscopic era.
Clin Anat., 17 (2004), pp. 294-299
[29]
J Loscertales, A Arroyo Tristán, M Congregado Loscertales, R Jiménez Merchan, J Girón Arjona, C Arenas Linares, et al.
Tratamiento de la hiperhidrosis palmar por simpatectomía torácica. Resultados inmediatos y calidad de vida postoperatoria.
Arch Bronconeumol., 40 (2004), pp. 67-71
[30]
JP Lefaucheur, M Fitoussi, JP Becquemin.
Abolition of sympathetic skin responses following endoscopic thoracic sympathectomy.
Copyright © 2006. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?