Top

Published in:

16-12-2022 | Hyperhidrosis | original article

Long-term results for palmar hyperhidrosis and palmar hyperhidrosis with axillary and/or plantar sweating: T3+T4 sympathicotomy vs. T4 sympathicotomy

Authors: Xiaoling Shen, MD, Yuchuan Luo, MD, Haifeng Hu, MD, Shaowen Zhang, MD, Jie Huang, MD, Songping Xie, MD, Gaoli Liu, MD, Hui Feng, MD

Published in: European Surgery | Issue 1/2023

Summary

Background

Sympathicotomy is currently the most effective treatment for palmar hyperhidrosis; however, there is a lack of consensus regarding treatment of patients with palmar hyperhidrosis accompanied by axillary and/or plantar sweating.

Methods

We retrospectively analysed the data of patients with palmar hyperhidrosis accompanied by axillary and/or plantar sweating who underwent bilateral thoracoscopic sympathicotomy and explored the optimal level of sympathicotomy.

Results

There was no significant difference in baseline characteristics and early postoperative results between the two groups. In the follow-up period, the improvement of the degree of palmar sweating in the T3+T4 group was better (p < 0.05). The incidence of compensatory hyperhidrosis was significantly rarer in group T4 (p < 0.05). For patients with palmar hyperhidrosis accompanied by axillary sweating, the improvement rate of axillary sweating was higher in group T3+T4, both at 1 month and 3 years after surgery (p < 0.05). For patients with palmar hyperhidrosis accompanied by plantar sweating, the improvement rate was 33.3% in group T4 and 70% in group T3+T4 at 3 years after surgery (p < 0.05). Satisfaction rate and recurrence rate showed no statistical significance between the two groups (all p > 0.05). Group T3+T4 had a lower the Hyperhidrosis Quality of Life Index score (p < 0.05).

Conclusion

Both T3+T4 sympathicotomy and T4 sympathicotomy were safe and effective, but T4 sympathicotomy led to a lower incidence of compensatory hyperhidrosis. T3+T4 sympathicotomy may be more suitable for patients with palmar hyperhidrosis accompanied by axillary and/or plantar sweating.

de Campos JR, Kauffman P, Werebe Ede C, et al. Quality of life, before and after thoracic sympathectomy: report on 378 operated patients. Ann Thorac Surg. 2003;76(3):895–6. https://doi.org/10.1016/s0003-4975.CrossRef

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):172–6. https://doi.org/10.1007/s10286-007-0420-5.CrossRef

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(1):130–3. https://doi.org/10.1016/j.jvs.2006.09.011.CrossRef

Kuijpers M, van Zanden JE, Harms PW, et al. Minimally invasive sympathicotomy for palmar hyperhidrosis and facial blushing: Current status and the hyperhidrosis expert center approach. JCM. 2022; https://doi.org/10.3390/jcm11030786.CrossRef

Turhan K, Kavurmaci Ö, Akçam T, et al. Long-term outcomes and course of compensatory sweating after endoscopic sympathicotomy. Thorac Cardiovasc Surg. 2022;70(2):167–72. https://doi.org/10.1055/s-0041-1728777.CrossRef

Arora G, Kassir M, Patil A, et al. Treatment of axillary hyperhidrosis. J of Cosmetic Dermatology. 2022;21(1):62–70. https://doi.org/10.1111/jocd.14378.CrossRef

Rieger R. Management of plantar hyperhidrosis with endoscopic lumbar sympathectomy. Thorac Surg Clin. 2016;26(4):465–9. https://doi.org/10.1016/j.thorsurg.2016.06.012.CrossRef

Nawrocki S, Cha J. The etiology, diagnosis, and management of hyperhidrosis: A comprehensive review. J Am Acad Dermatol. 2019;81(3):657–66. https://doi.org/10.1016/j.jaad.2018.12.071.CrossRef

Hornberger J, Grimes K, Naumann M, et al. Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol. 2004;51(2):274–86. https://doi.org/10.1016/j.jaad.2003.12.029.CrossRef

10.

Kamudoni P, Mueller B, Salek MS. The development and validation of a disease-specific quality of life measure in hyperhidrosis: the Hyperhidrosis Quality of Life Index (HidroQOL©). Qual Life Res. 2015;24(4):1017–27. https://doi.org/10.1007/s11136-014-0825-2.CrossRef

11.

Wolosker N, de Campos JRM, Kauffman P, et al. Cohort study on 20 years’ experience of bilateral video-assisted thoracic sympathectomy (VATS) for treatment of hyperhidrosis in 2431 patients. Sao Paulo Med J. 2022;140(2):284–9. https://doi.org/10.1590/1516-3180.2021.0078.R1.23072021.CrossRef

12.

Alkosha HM, Abuelnasr T, Mohammed M. Efficacy and outcome prediction of unilateral video-assisted thoracoscopic sympathectomy in primary palmar hyperhidrosis: a comparative study with bilateral sympathectomy. World Neurosurgery. 2022; https://doi.org/10.1016/j.wneu.2022.02.005.CrossRef

13.

Singh S, Davis H, Wilson P. Axillary hyperhidrosis: A review of the extent of the problem and treatment modalities. Surgeon. 2015;13(5):279–85. https://doi.org/10.1016/j.surge.2015.03.003.CrossRef

14.

Munia MA, Wolosker N, Kaufmann P, de Campos JR, Puech-Leão P. Sustained benefit lasting one year from T4 instead of T3–T4 sympathectomy for isolated axillary hyperhidrosis. Clinics. 2008;63(6):771–4. https://doi.org/10.1590/s1807-59322008000600011.CrossRef

15.

Puri HV, Asaf BB, Bishnoi S, Pulle MV, Sharma S, Kumar A. Thoracoscopic bilateral dorsal sympathectomy for primary palmo-axillary hyperhidrosis short- and mid-term results. J Min Access Surg. 2021;17(4):532–6. https://doi.org/10.4103/jmas.JMAS_174_20.CrossRef

16.

Vlahovic TC. Plantar hyperhidrosis: An overview. Clin Podiatr Med Surg. 2016;33(3):441–51. https://doi.org/10.1016/j.cpm.2016.02.010.CrossRef

17.

Yang C, Li Z, Bai H, et al. Long-term efficacy of T3 versus T3+T4 thoracoscopic sympathectomy for concurrent palmar and plantar hyperhidrosis. J Surg Res. 2021;263:224–9. https://doi.org/10.1016/j.jss.2020.11.064.CrossRef

18.

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(3):1048–55. https://doi.org/10.1016/j.athoracsur.2005.09.046.CrossRef

19.

Fredman B, Zohar E, Shachor D, Bendahan J, Jedeikin R. Video-assisted transthoracic sympathectomy in the treatment of primary hyperhidrosis: friend or foe? Surg Laparosc Endosc Percutaneous Tech. 2000;10(4):226–9.CrossRef

20.

Rantanen T, Telaranta T. Long-term results of endoscopic sympathetic block using the Lin-Telaranta classification. Surg Endosc. 2013;27(10):3860–4. https://doi.org/10.1007/s00464-013-2995-3.CrossRef

21.

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):1370–6. https://doi.org/10.1016/j.jtcvs.2009.01.008. discussion 1376–1377.CrossRef

22.

Loscertales J, Congregado M, Jimenez-Merchan R, et al. Sympathetic chain clipping for hyperhidrosis is not a reversible procedure. Surg Endosc. 2012;26(5):1258–63. https://doi.org/10.1007/s00464-011-2023-4.CrossRef

23.

Liu Y, Yang J, Liu J, et al. Surgical treatment of primary palmar hyperhidrosis: a prospective randomized study comparing T3 and T4 sympathicotomy. Eur J Cardiothorac Surg. 2009;35(3):398–402. https://doi.org/10.1016/j.ejcts.2008.10.048.CrossRef

24.

Abd Ellatif ME, Hadidi AE, Musa AM, et al. Optimal level of sympathectomy for primary palmar hyperhidrosis: T3 versus T4 in a retrospective cohort study. Int J Surg. 2014;12(8):778–82. https://doi.org/10.1016/j.ijsu.2014.05.039.CrossRef

25.

Drott C, Claes G. Hyperhidrosis treated by thoracoscopic sympathicotomy. Cardiovasc Surg. 1996;4(6):788–90. https://doi.org/10.1016/s0967-2109(96)00048-8. discussion 790–781.CrossRef

26.

Cho HM, Lee DY, Sung SW. Anatomical variations of rami communicantes in the upper thoracic sympathetic trunk. Eur J Cardiothorac Surg. 2005;27(2):320–4. https://doi.org/10.1016/j.ejcts.2004.10.057.CrossRef

27.

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):514–9. https://doi.org/10.1016/j.ejcts.2008.05.036.CrossRef

28.

Xie H, Lu T, Zhu Y, et al. A retrospective cohort study of T3 versus T4 thoracoscopic sympathectomy for primary palmar hyperhidrosis and primary palmar hyperhidrosis with axillary and plantar sweating. Wideochirurgia i inne techniki maloinwazyjne. 2020;15(3):488–95. https://doi.org/10.5114/wiitm.2019.89656.CrossRef

Title: Long-term results for palmar hyperhidrosis and palmar hyperhidrosis with axillary and/or plantar sweating: T3+T4 sympathicotomy vs. T4 sympathicotomy
Authors: Xiaoling Shen, MD
Yuchuan Luo, MD
Haifeng Hu, MD
Shaowen Zhang, MD
Jie Huang, MD
Songping Xie, MD
Gaoli Liu, MD
Hui Feng, MD
Publication date: 16-12-2022
Publisher: Springer Vienna
Keyword: Hyperhidrosis
Published in: European Surgery / Issue 1/2023
Print ISSN: 1682-8631
Electronic ISSN: 1682-4016
DOI: https://doi.org/10.1007/s10353-022-00786-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Long-term results for palmar hyperhidrosis and palmar hyperhidrosis with axillary and/or plantar sweating: T3+T4 sympathicotomy vs. T4 sympathicotomy

Summary

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Summary

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2023

Impact of previous abdominal surgery on the outcome of fundoplication for medically refractory gastroesophageal reflux disease in children and young adults

Real-world evidence with magnetic sphincter augmentation for gastroesophageal reflux disease: a scoping review

Gender-specific prevalence of sacrococcygeal pilonidal sinus disease in Turkey: A retrospective analysis of a large cohort

Advances in surgery under the Second French Empire of Napoleon III (1852–1870)

Surgery senses the joy of nature and sciences

Book review