Usefulness of Bilateral Sympathectomy Using Video-Assisted Thorascopic Surgery in the Treatment of Essential Hyperhidrosis

García Franco, C.E.; España, A.

doi:10.1016/S1578-2190(08)70308-1

Article information

Abstract

Bibliography

Download PDF

Statistics

Abstract

Essential, idiopathic, or primary hyperhidrosis is defined as excessive sweating in certain areas of the body due to factors unrelated to other disease. Clinical presentation can be categorized as palmar, plantar, axillary, or craniofacial. Medical treatment (aluminium salts, iontophoresis, anticholinergic drugs, and alfa-2-agonists) is of questionable effectiveness. Intradermal injections of botulinum toxin are very effective for the treatment of axillary hyperhidrosis. Surgical treatment involves resection (sympathectomy) or electrocautery (sympathicolysis) of the thoracic sympathetic chain, or compression of the sympathetic chain with clips, in all cases via video-assisted thorascopic surgery. One or more ganglia between T2 and T5 are usually resected depending on the area affected by hyperhidrosis: T2 for craniofacial hyperhidrosis, T3 and T4 for palmar hyperhidrosis, and T3 to T5 for combined palmar and axillary hyperhidrosis. The technique is very useful and is effective in those patients with primary hyperhidrosis who have not responded to conservative treatment.

Key words:

palmar

plantar

axillary

craniofacial

hyperhidrosis

thoracic sympathetic chain

botulinum toxin

endoscopic thoracic sympathectomy

Resumen

Se define como hiperhidrosis esencial, idiopática o primaria la excesiva sudoración de determinadas áreas del cuerpo debido a una causa no asociada a otras patologías. Distinguimos 4 formas de presentación clínica: palmar, plantar, axilar y/o cráneo-facial. El tratamiento médico (sales de aluminio, iontoforesis, anticolinérgicos y alfa-2-agonistas) tiene una eficacia cuestionada. El tratamiento con inyecciones intradérmicas de toxina botulínica tiene una gran eficacia en el tratamiento de la hiperhidrosis axilar. El tratamiento quirúrgico consiste en la resección de la cadena simpática ganglionar torácica (simpatectomía), en la electrocoagulación de ésta (simpaticolisis) o en la compresión de la cadena con clips; todas ellas mediante cirugía videotoracoscópica. Se suelen seccionar una o varias estaciones situadas entre T2 y T5 en función del área afecta de hiperhidrosis: T2 para la hiperhidrosis cráneo-facial, T3-4 para la palmar, T3-T5 para la palmar y la axilar asociadas. La técnica resulta de gran utilidad y eficacia en aquellos pacientes con hiperhidrosis primaria que no hayan respondido al tratamiento conservador.

Palabras clave:

hiperhidrosis palmar

axilar

plantar y/o cráneo-facial

cadena simpática ganglionar torácica

toxina botulínica

simpatectomía torácica endoscópica

Full text is only aviable in PDF

References

[1.]

J. Hornberg, K. Grimes, M. Naumann, D.A. Glaser, N.J. Lowe, H. Naver, et al.

Recognition, diagnosis and treatment of primary focal hyperhidrosis.

J Am Acad Dermatol, 51 (2004), pp. 274-286

http://dx.doi.org/10.1016/j.jaad.2003.12.029 | Medline

[2.]

R. Grimalt, M.A. Callejas.

Hiperhidrosis: diagnóstico y tratamientos actuales.

Médica Panamericana, (2004),

[3.]

J.H. Eisenach, J.L. Atkinson, R.D. Fealey.

Hyperhidrosis: evolving therapies for a well-established phenomenon.

Mayo Clinic Proc, 80 (2005), pp. 657-666

[4.]

C. Braune, F. Erbguth, F. Birklein.

Dose thresholds and duration of local anhidrotic effect of botulinum toxin injections: measured by sudometry.

Br J Dermatol, 144 (2001), pp. 111-117

Medline

[5.]

E.M. Torch.

Remission of facial and scalp hyperhidrosis with clonidine hydrochloride and topical aluminium chloride.

South Med J, 93 (2000), pp. 264

[6.]

J.C. White, R.H. Smithwick, A.W. Allen.

A new muscle splitting incision for resection of the upper thoracic sympathetic ganglia.

Surg Gynecol Obstet, 56 (1933), pp. 651-657

[7.]

E. Kux.

Thorakoskopische eingriffe am Nervensystem.

Georg Thieme Verlag, (1954),

[8.]

P. Dumont, A. Denoyer, P. Robin.

Long term results of thoracoscopic sympathectomy for hyperhidrosis.

Ann Thorac Surg, 78 (2004), pp. 1801-1807

http://dx.doi.org/10.1016/j.athoracsur.2004.03.012 | Medline

[9.]

J. Moya, R. Ramos, R. Morera, R. Villalonga, V. Perna, I. Macia, et al.

Thoracic sympathicolysis for primary hyperhidrosis: a review of 918 procedures.

Surg Endosc, 20 (2006), pp. 598-602

http://dx.doi.org/10.1007/s00464-005-0557-z | Medline

[10.]

J. Loscertales, A. Arroyo Tristán, M. Congregado Loscertales, R. Jiménez Merchán, J.C. 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

Medline

[11.]

C. Drott, G. Göthberg, G. Claes.

Endoscopic transthoracic sympathectomy: an efficient and safe method for treatment of hyperhidrosis.

J Am Acad Dermatol, 33 (1995), pp. 78-81

Medline

[12.]

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 Thor Surg, 75 (2003), pp. 1075-1079

[13.]

J.L. Atkinson, R.D. Fealey.

Sympathotomy instead of sympathectomy for palmar hyperhidrosis: minimizing postoperative compensatory hyperhidrosis.

Mayo Clin Proc, 78 (2003), pp. 167-172

http://dx.doi.org/10.4065/78.2.167 | Medline

[14.]

T.M. Dewey, M.A. Herbert, S.L. Hill, S.L. Prince, M.J. Mack, et al.

One year follow up after thoracoscopic sympathectomy for hyperhidrosis: outcomes and consequences.

Ann Thorac Surg, 81 (2006), pp. 1227-1233

http://dx.doi.org/10.1016/j.athoracsur.2005.11.006 | Medline

[15.]

K.T. Kim, S.A. Lee.

Thoracoscopic T3-sympathicotomy for palmar hyperhidrosis.

Presented at the 3rd International symposium on Thoracoscopic Sympathicotomy,

[16.]

R. Reisfeld, R. Nguyen, A. Pnini.

Endoscopic thoracic sympathectomy for treatment of essential hyperhidrosis syndrome: experience with 650 patients.

Surg Laparosc Endosc Percutan Tech, 10 (2000), pp. 5-10

Medline

[17.]

R. Reisfeld, R. Nguyen, A. Pnini.

Endoscopic thoracic sympathectomy for hyperhidrosis: experience with both cauterization and clamping methods.

Surg Laparosc Endosc Percutan Tech, 12 (2002), pp. 255-267

Medline

[18.]

C. Neumayer, P. Panhofer, J. Zacherl, G. Bischof.

Effect of endoscopic thoracic sympathetic block on plantar hyperhidrosis.

Arch Surg, 140 (2005), pp. 676-680

http://dx.doi.org/10.1001/archsurg.140.7.676 | Medline

[19.]

R. Rieger, S. Pedevilla.

Retroperitoneoscopic lumbar sympathectomy for the treatment of plantar hyperhidrosis: technique and preliminary findings.

Surg Endosc, 21 (2007), pp. 129-135

http://dx.doi.org/10.1007/s00464-005-0690-8 | Medline

[20.]

F.G. Bechara, M. Sand, D. Sand, P. Altmeyer, K. Hoffmann.

Suction-curettage as a surgical treatment of focal axillary hyperhidrosis: recommendation for an aggressive approach.

Plast Reconstr Surg, 119 (2007), pp. 1390-1391

http://dx.doi.org/10.1097/01.prs.0000255195.61014.4b | Medline

Indexed in:

Follow us:

Indexed in:

Follow us:

Subscribe to our newsletter