CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 4, May 2013
AFRICA
137
Bilateral thoracoscopic sympathectomy for primary
hyperhydrosis: a review of 335 cases
MURAT ÖNCEL, GÜVEN SADI SUNAM, ESREF ERDEM, YÜKSEL DERELI, BEKIR TEZCAN , KAZIM GÜROL AKYOL
Abstract
Objective:
The goal of this retrospective study was to evalu-
ate the outcomes of bilateral video-assisted thoracoscopic
sympathectomy for primary hyperhydrosis.
Methods:
Between January 2007 and December 2011, a total
of 335 patients (192 male, 143 female, mean age 28.3 years)
who underwent bilateral thoracoscopic sympathectomy for
primary hyperhydrosis were reviewed retrospectively.
Results:
Hyperhydrosis occurred in the palmar and axillary
region in 175 (52.23%) patients, in only the palmar region in
52 (15.52%), in the craniofacial region in 44 (13.13%), in only
the axillary region in 42 (12.53%), and in the palmar and
pedal regions in 22 (6.56%) patients. Bilateral thoracoscopic
sympathectomy was performed in all patients. The mean
follow-up period was 24 (6–48) months. The initial cure rate
was 95% and the initial satisfaction rate was 93%. There was
no mortality in this study. The complication rate was 15.82%
in 53 patients.
Conclusion:
Video-assisted thoracoscopic sympathectomy for
the treatment of primary hyperhydrosis was effective, with
low rates of morbidity and mortality. Despite the appearance
of postoperative complications, such as compensatory sweat-
ing, patient satisfaction with the procedure was high and
their quality of life improved.
Keywords:
primary hyperhydrosis, bilateral thoracoscopic
sympathectomy, VATS
Submitted 23/7/12, accepted 24/1/13
Cardiovasc J Afr
2013;
24
: 137–140
DOI: 10.5830/CVJA-2013-007
Primary hyperhydrosis is a disorder characterised by excessive
diffuse or localised sweating. Although its pathophysiology
is unknown, it is believed to be caused by hyper-stimulation
or over-activity of the sympathetic nervous system.
1
It most
often affects the palms of the hands, the axillae, or the face.
Although not life-threatening, hyperhydrosis causes educational
and occupational difficulties, as well as psychological and social
problems. Medical treatment is often ineffective and the response
is usually transient.
Thoracoscopic sympathectomy is the current standard
treatment for primary hyperhydrosis. This procedure is easy,
safe, fast, effective and minimally invasive. The most common
side effect of this method is compensatory sweating (CS) and it
is believed to be due to a thermoregulatory mechanism.
2
In this
study, we present our experience with this technique.
Methods
Atotal of 335patients underwent one-stage bilateral thoracoscopic
sympathectomy for treatment of primary palmar hyperhidrosis,
by the same surgical team. All patients had failed to respond to
adequate medical treatment and were referred for surgery.
Selection criteria included absence of previous thoracic
surgery, severe and debilitating primary palmar hyperhydrosis,
repercussions on social life, repercussions on professional activity,
effect on intimate relationship, inefficacy of medical treatment,
and patient motivation and determination. Each patient signed
an informed consent after having been carefully educated on the
possible side effects, such as transient compensatory dry-hand
sweating, intercostal pain, Horner syndrome, pneumothoax and
haemopneumothorax.
General anaesthesia using the single lung-isolation technique
with a double-lumen endotracheal tube was used in all patients.
The patients were positioned in a semi-sitting position with their
arms in abduction. Patients were placed in a semi-prone position
for each side of the procedure, with the ipsilateral arm abducted
and a mild anti-Trendeleburg position.
Monitoring included saturation, blood pressure and electro-
cardiogram. In those patients undergoing general anesthesia,
one-lung ventilation was administered using a double-lumen
endotracheal tube. Thoracoscopic ports were placed, respec-
tively, in the fourth intercostal space on the mid-axillary line and
the third intercostal space anterior to the mid-axillary line.
All patients underwent division of their sympathetic chain
using controlled intermittent electrocautery after identifying
the first rib. The T1 chain was kept for Horner syndrome
surgical ablation of the sympathetic chain between T2 and
T3, and electrocautery ablation of the accessory branches
and Kuntz nerve, when present, was performed in all cases to
prevent relapse of the health status immediately before and six
months after surgery. In five patients, very thin adhesions were
encountered that could easily be eliminated by electrocautery.
A postoperative chest X-ray was performed in the recovery
room to verify the absence of a significant haemothorax or
pneumothorax. A temporary intra-operative paediatric chest
tube was inserted into the chest during closure of the incisional
soft tissues but was removed before tying down the skin closure
suture.
Department of Thoracic Surgery, Selcuklu Medicine Faculty,
Selcuk University, Konya, Turkey
MURAT ÖNCEL, MD,
GÜVEN SADI SUNAM, MD
ESREF ERDEM, MD
Department of Cardiovascular Surgery, Numune State
Hospital, Konya, Turkey
YÜKSEL DERELI, MD
Department of Thoracic Surgery, Numune State Hospital,
Konya, Turkey
BEKIR TEZCAN, MD
KAZIM GÜROL AKYOL, MD
