Sympathectomy for hyperhydrosis

The aim of this study was to compare the results of simultaneous bilateral thoracodorsal sympathectomy in the prone position with those of anterolateral sympathectomy performed in two staged, separate procedures for the treatment of bilateral excessive sweating of the hands and axillae, and to describe our technique for bilateral, simultaneous thoracodorsal sympathectomy. From July 1995 to March 2001, 202 thoracodorsal sympathectomies were done in 101 patients for severe hyperhydrosis. There were 79 females (age range 20-46) and 22 males (age range 19-65)...

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In this prospective cohort study, the outcome of bilateral endoscopic transthoracic sympathectomy (ETS) was assessed using the Dermatology Life Quality Index (DLQI) questionnaire. 10 consecutive patients who underwent two-stage bilateral ETS for primary hyperhydrosis were assessed. Two patients had concomitant facial blushing. Symptomatic improvement was achieved in all patients. Statistical analysis (one-tailed Wilcoxon rank test) demonstrates a significant (p < 0.05) step-wise improvement in quality of life after each stage...

OBJECTIVE: To evaluate the efficacy of bilateral transthoracic endoscopic sympathectomy (TES), in alleviating symptoms and improving quality of life for patients in Hawaii. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Patients who had undergone TES were evaluated by phone interview and the SF-36 questionnaire to assess improvements in symptoms and the development of compensatory hyperhydrosis. SF-36 scores were divided into 8 scales and evaluated by one-tailed t-test...

Primary palmar hyperhydrosis is a functionally and socially disabling problem of unknown etiology, affecting adolescents and young adults, especially in hot climates. Thoracoscopic sympathectomy is the most effective treatment for palmar hyperhydrosis. Postsympathectomy rebound hyperhydrosis may limit its success, especially in hot climates. The aim of this study is to report experience with thoracoscopic sympathectomy in a hot climate, managing the dominant hand (unilateral), followed by the other hand at a later date, based on the patient's choice...

OBJECTIVE: Nitric oxide exerts its cardiovascular actions at least in part by modulation of the sympathetic vasoconstrictor tone. There is increasing evidence that nitric oxide inhibits central neural sympathetic outflow, and preliminary evidence suggests that it may also modulate peripheral sympathetic vasoconstrictor tone. METHODS: To test this latter concept, in six subjects having undergone thoracic sympathectomy for hyperhydrosis, we compared the vascular responses to systemic L-NMMA infusion (1 mg/kg/min over 10 min) in the innervated and the denervated limb...

This study reports our experience of using thoracoscopic cervicodorsal sympathectomy with diathermy. From December 1994 to September 1998, we performed 53 thoracoscopic sympathectomies in 35 patients. There were 15 men and 20 women, ages 18 to 61 years. Ten surgeries were performed on the right side, 7 were the left, and 18 were bilateral. Indications for surgery were causalgia/reflex sympathetic dystrophy in 8 patients, Raynaud's/vasculitis in 6, intractable Raynaud's disease in 4, and hyperhydrosis in 17 (bilateral procedure)...

OBJECTIVE: 48 patients underwent TSSYM. Charts of patients undergoing thoracoscopy were reviewed to assess the safety and efficacy of thoracoscopic sympathectomy (TSSYM). DESIGN: A retrospective review was undertaken at four United States medical centers. RESULTS: TSSYM was performed for reflex sympathetic dystrophy in 27 patients, hyperhydrosis palmaris in 15 patients, and Raynaud's upper extremity ischemia and splanchnic pain in 2 patients each...

OBJECTIVE: To investigate the roles of the second and third thoracic spinal segments in the preganglionic sympathetic innervation of the hand, and to compare skin temperature changes between thenar and other parts of palm before, during, and after endoscopic thoracic sympathectomy. DESIGN: Twelve patients, four women and eight men, with severe palmar hyperhydrosis underwent endoscopic thoracic sympathectomy. The T3 segment was identified and dissected first, followed by T2 segment extirpation...

A technique is described for using a clip-suture to expedite handling of the divided sympathetic chain in a deep, small upper-thoracic exposure. No late failures were experienced in 23 patients with hyperhydrosis surgically treated using this technique.

Doppler ultrasonic examination has been used as an indirect means of per-operative checking of sweat secretion after non surgical upper dorsal sympathectomy performed by percutaneous injection of hot saline into the upper dorsal sympathetic ganglions for the treatment of palmar hyperhydrosis. Their experience with pre, per and post-operative utilisation of Doppler effect in sixty cases has evidenced a full parallelism between the arterial vasodilation and the decrease in sweat secretion following the destruction of the sympathetic ganglions by hot saline...

Thoracic endoscopic sympathectomy (TES) is a short surgical procedure used for the treatment of axillary and palmar hyperhydrosis. It involves creation of tension pneumothorax, lateral and head-up position and necessitates minimal lung excursions during breathing, so that a special anaesthetic technique is required. In six otherwise healthy patients an endobronchial double lumen tube was used for one-lung ventilation with intravenous anaesthesia and muscular relaxation, and circulatory response, FE CO2 and blood gases were monitored in order to compare this anaesthetic technique to conventional endotracheal intubation in previous patients...

To evaluate the role of the sympathetic nervous system in modulating esophageal motility, esophageal manometry was performed on two groups of patients who underwent upper dorsal sympathectomy for relief of palmar hyperhydrosis. In six patients sympathectomy was done by the supraclavicular approach, with removal of T2 and T3 ganglia. Manometry was performed before the operation and three weeks after it. In seven other patients sympathectomy was done by the axillary approach, with removal of T2-T4 ganglia. Manometry in this group was performed 28...

An analysis of upper thoracic sympathectomy for palmar hyperhydrosis performed in a Neurological Department for the past ten years via several surgical approaches suggests that the posterior median approach is preferable. Histological confirmation of ganglion cells at time of surgery is recommended.