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

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

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