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Lumbar sympathectomy for plantar hyperhidrosis

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  #1  
Old 9th February 2007, 03:21 PM
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Default Lumbar sympathectomy for plantar hyperhidrosis

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Retroperitoneoscopic lumbar sympathectomy for the treatment of plantar hyperhidrosis: technique and preliminary findings.
Surg Endosc. 2007 Jan;21(1):129-35
Rieger R, Pedevilla S
Quote:
BACKGROUND: Patients with plantar hyperhidrosis suffer physically and mentally from a disease that often cannot be treated sufficiently using conservative measures. This article reports the authors' experience with endoscopic lumbar sympathectomies for patients with plantar hyperhidrosis.

METHODS: Bilateral lumbar sympathectomy was performed for eight patients (3 women and 5 men). A retroperitoneoscopic surgical technique was used, during which the lower lumbar sympathetic trunk was resected after radiologic localization of the lumbar spine, with care taken to protect the cranial lumbar ganglia.

RESULTS: All 16 sympathectomies were conducted retroperitoneoscopically, with no intra- or postoperative complications. In all cases, pedal sweat secretion was completely suspended postoperatively. After a 3- to 8-month follow-up period, the anhidrosis persisted in all cases (100%). None of the patients experienced sexual dysfunction. Five patients (62%) reportedly experienced minor compensatory sweating of the torso, and four patients (50%) had postsympathectomy neuralgia. Seven of eight patients were very happy with the postoperative results and would agree to a repeat of the intervention any time.

CONCLUSIONS: Retroperitoneoscopic resection of the lower lumbar sympathetic trunk is a safe and effective procedure for obtaining suspension of excessive sweat secretion in patients with plantar hyperhidrosis that cannot be treated with conservative methods.
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Old 9th February 2007, 03:34 PM
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Default Re: Lumbar sympathectomy for plantar hyperhidrosis

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Old 20th October 2009, 05:53 PM
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Default Re: Lumbar sympathectomy for plantar hyperhidrosis

An assessment of plantar hyperhidrosis after endoscopic thoracic sympathicolysis.
Ureña A, Ramos R, Masuet C, Macia I, Rivas F, Escobar I, Villalonga R, Moya J.
Eur J Cardiothorac Surg. 2009 Aug;36(2):360-3.
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BACKGROUND: Endoscopic bilateral thoracic sympathicolysis (EBTS) is an effective and minimally invasive procedure used for patients with primary hyperhidrosis. The purpose of this study was to examine plantar hyperhidrosis before and after EBTS.

METHODS: A total of 198 patients with primary hyperhidrosis underwent 396 thoracoscopic sympathicolysis of ganglia T2-T3 in a prospective study. All completed a preoperative questionnaire, followed by a second questionnaire 12 months after the operation. The questionnaires evaluated sweating in the different body areas. Only the zones of anhydrosis were considered in delimiting the cutaneous expression of sympathetic ganglia T2-T3.

RESULTS: Redistribution of perspiration as reported by the patients comprised significant reductions in palmar and axillary hyperhidrosis, and an increase in the zone of the trunk and popliteal region. The incidence of plantar anhydrosis and plantar hypohidrosis was 30.3% and 20.7%, respectively (p < 0.001).

CONCLUSIONS: EBTS is followed by redistribution of body perspiration, with, and important, plantar anhydrosis and hypohidrosis. Although EBTS is the standard treatment for palmar primary hyperhidrosis, we must continue studying baseline sympathetic activity in patients affected by primary hyperhidrosis and the neuroanatomy of the sympathetic system to understand the redistribution of sweating and decrease of hyperhidrosis in the zones regulated by mental or emotional stimuli.
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Old 16th December 2009, 03:10 PM
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Default Re: Lumbar sympathectomy for plantar hyperhidrosis

Endoscopic lumbar sympathectomy for plantar hyperhidrosis.
Rieger R, Pedevilla S, Pöchlauer S.
Br J Surg. 2009 Dec;96(12):1422-8.
Quote:
BACKGROUND: The aim of this study was to evaluate the results of endoscopic lumbar sympathectomy for plantar hyperhidrosis.

METHODS: A total of 178 endoscopic resections of the lower sympathetic lumbar trunk were carried out in 90 patients (59 men, 31 women) with severe plantar hyperhidrosis. The clinical results, including morbidity and satisfaction rates, were evaluated. Follow-up examination was carried out for all patients after a mean follow-up of 24 (range 3-45) months.

RESULTS: All procedures were carried out endoscopically. There were no deaths and only three patients had a postoperative complication. All patients had evidence of postoperative sympathetic denervation of the feet. In 87 patients (97 per cent) hyperhidrosis was eliminated, but in three (3 per cent) it recurred. Compensatory sweating occurred in 40 patients (44 per cent), postsympathectomy neuralgia in 38 (42 per cent) and one man suffered temporary loss of ejaculation. A total of 86 patients (96 per cent) were very, or partly, satisfied with the result, and 83 (92 per cent) would have the procedure repeated if required.

CONCLUSION: Endoscopic lumbar sympathectomy was a safe and effective option for patients with severe plantar hyperhidrosis
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Old 24th July 2010, 02:35 AM
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Default Re: Lumbar sympathectomy for plantar hyperhidrosis

Chemical lumbar sympathectomy in plantar hyperhidrosis.
Yoshida WB, Cataneo DC, Bomfim GA, Hasimoto E, Cataneo AJ.
Clin Auton Res. 2010 Apr;20(2):113-5. Epub 2009 Dec 11.
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Plantar hyperhidrosis can cause great changes to an individual's quality of life. We described a case successfully treated by the minimally invasive method of percutaneous injection of 7.0% phenolic solution into the lumbar sympathetic chains.
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Old 24th August 2010, 03:01 PM
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Default Re: Lumbar sympathectomy for plantar hyperhidrosis

Endoscopic lumbar sympathectomy for focal plantar hyperhidrosis using the clamping method.
Reisfeld R.

Surg Laparosc Endosc Percutan Tech. 2010 Aug;20(4):231-6.

Quote:
Surgical treatment for focal plantar hyperhidrosis is not yet well studied. Bilateral endoscopic lumbar sympathectomy (ELS), using the clamping method, was performed in 63 patients with focal plantar hyperhidrosis. Clamps were placed at L3 (46.0%) or L4 (52.4%), with one case at L2. All patients had improvement in foot sweating, with 96.6% achieving total anhidrosis. Five early cases had to be converted to an open surgical method. Complications were rare. No sexual problems were reported by the male patients. Compensatory sweating, already present in those with prior thoracic sympathectomy (n=56), remained unchanged in 91.1% and no severe compensatory sweating occurred in those who had only ELS. Postoperative pain was minimal. ELS is a viable option in the treatment of plantar hyperhidrosis, whether after a thoracic sympathectomy or in primary cases of plantar hyperhidrosis. Use of the clamping method provides good results with minimal postoperative pain or other complications.
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Old 23rd December 2010, 05:43 PM
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Default Re: Lumbar sympathectomy for plantar hyperhidrosis

Factors affecting long-term satisfaction after thoracic sympathectomy for palmar and plantar hyperhidrosis. Is the sudomotor reflex the only villain?
de Lima AG, Das-Neves-Pereira JC, de Campos JR, Jatene FB.
Interact Cardiovasc Thorac Surg. 2010 Dec 20. [Epub ahead of print]
Quote:
The main objective of this study was to determine if there are variations in the level of improvement of the palmar and plantar hyperhidrotic symptoms, as well as the incidence and intensity of the sudomotor reflex, throughout the seasons of the year, after thoracic sympathectomy for hyperhidrosis. The study also looks for the real impact of these variables in the long-term satisfaction. A cohort of 75 patients was followed through distinct seasons. A multivariate analysis was performed to identify possible variables responsible for dissatisfaction. Both the palmar (P=0.002) and plantar (P<0.001) symptoms and the presence and the intensity of the sudomotor reflex varies significantly throughout the seasons of the year. The sudomotor reflex was the main factor associated with low satisfaction in our patients in the summer (P=0.025) and winter (P<0.001) but in spring the lack of improvement in the hyperhidrosis in the foot was the unique factor related to dissatisfaction (P<0.001). The sudomotor reflex is the main negative factor in the summer and in the winter, independent of its intensity. However, at least in spring, the lack of removal of the plantar symptoms had a negative impact on satisfaction.
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Old 1st October 2011, 01:59 PM
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Default Re: Lumbar sympathectomy for plantar hyperhidrosis

Endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis: outcomes and complications during a 10-year period.
Atkinson JL, Fode-Thomas NC, Fealey RD, Eisenach JH, Goerss SJ.
Mayo Clin Proc. 2011 Aug;86(8):721-9.
Quote:
OBJECTIVE:
To review surgical results of endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis during the past decade.

PATIENTS AND METHODS:
We retrospectively reviewed 155 consecutive patients who underwent surgery from June 30, 2000, through December 31, 2009, for medically refractory palmar-plantar hyperhidrosis using a technique of T1-T2 sympathotomy disconnection, designed for successful palmar response and minimization of complications.

RESULTS:
Of the 155 patients, 44 (28.4%) were male, and 111 (71.6%) were female; operative times averaged 38 minutes. No patient experienced Horner syndrome, intercostal neuralgia, or pneumothorax. The only surgical complication was hemothorax in 2 patients (1.3%); in 1 patient, it occurred immediately postoperatively and in the other patient, 10 days postoperatively; treatment in both patients was successful. All 155 patients had successful (warm and dry) palmar responses at discharge. Long-term follow-up (>3 months; mean, 40.2 months) was obtained for 148 patients (95.5%) with the following responses to surgery: 96.6% of patients experienced successful control of palmar sweating; 69.2% of patients experienced decreased axillary sweating; and 39.8% of patients experienced decreased plantar sweating. At follow-up, 5 patients had palmar sweating (3 patients, <3 months; 1 patient, 10-12 months; 1 patient, 16-18 months). Compensatory hyperhidrosis did not occur in 47 patients (31.7%); it was mild in 92 patients (62.2%), moderate in 7 patients (4.7%), and severe in 2 patients (1.3%).

CONCLUSION:
In this series, a small-diameter uniportal approach has eliminated intercostal neuralgia. Selecting a T1-T2 sympathotomy yields an excellent palmar response, with a very low severe compensatory hyperhidrosis complication rate. The low failure rate was noted during 18 months of follow-up and suggests that longer follow-up is necessary in these patients.
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Old 5th June 2012, 01:17 PM
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Default Re: Lumbar sympathectomy for plantar hyperhidrosis

Clinical Importance of CT-Assisted Sympathicolysis in Primary, Focal Plantar and Palmar Hyperhidrosis.
Scheer F, Wins A, Kamusella P, Wiggermann P, Wissgott C, Andresen R.
Rofo. 2012 Jun 1
Quote:
Purpose: The objective of this study was to evaluate the benefit of thoracic and lumbar computed tomographic-assisted sympathicolysis (CTSy) in patients with primary, focal hyperhidrosis.

Materials and Methods: Thoracic and/or lumbar CTSy was conducted on 101 patients (average age 37.5 ± 15.5 years) with primary, focal hyperhidrosis of the hands and/or feet, who experienced persistent symptoms after all conservative treatment options had been exhausted. The patients were divided into groups with palmar, palmoplantar and plantar hyperhidrosis. The patients evaluated the severity of their symptoms prior to the intervention and 2 days, 6 months and 12 months after the intervention using a Dermatology Quality of Life Index (DLQI) and side effects.

Results: The performed interventions led to a statistically significant decrease in the preinterventional severity of symptoms after the intervention (2 days), and 6 and 12 months after CTSy in the palmar, palmoplantar and plantar (p < 0.01) group. The technical success rate of CTSy was 100 %. No major complications occurred. Patients reported compensatory perspiration over the course of treatment, neuralgia and paraesthesia as side effects. The differentiated assessment of the strength of perspiration of the hands and feet showed statistically significant differences between the foot and hand region, whereby the decrease in sweat secretion of the feet was more significant and more lasting (p < 0.02).

Conclusion: After conservative measures have been exhausted, CT-assisted sympathicolysis represents a therapeutic option with minimal side effects for patients with primary, focal hyperhidrosis.
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Old 14th December 2012, 09:00 PM
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Default Re: Lumbar sympathectomy for plantar hyperhidrosis

Review of the surgical technique for the treatment of hyperhidrosis
Nelson Wolosker, Mariana Krutman, Paulo Kauffman, Jose Ribas M de Campos and Pedro Puech-Leão
Expert Review of Dermatology; December 2012, Vol. 7, No. 6, Pages 529-538

Quote:
Hyperhidrosis is a condition that affects 3% of the general population and intereferes in social, professional and emotional spheres. A growing awareness of this condition and the possibility of treatment have led to an increase in patient demand for effective therapeutic measures. Up until the present moment, thoracoscopic sympathectomy is still the most efficient option for a definite control of excessive sweating. The authors will review the history of sympathectomy, basic anatomical and physiological details and discuss the main indication for video-assisted thoracoscopy sympathectomy (essential hyperhidrosis), summarizing technical details, surgical results and complications, as well as alternatives to sympathectomy.
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Old 15th February 2013, 10:03 PM
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Default Re: Lumbar sympathectomy for plantar hyperhidrosis

Technical Difficulties and Complications of Sympathectomy in the Treatment of Hyperhidrosis: An Analysis of 1731 Cases
Laert Oliveira de Andrade Filho, Sérgio Kuzniec, Nelson Woloskeremail address, Guilherme Yazbek, Paulo Kauffman, José Ribas Milanez de Campos
Annals of Vascular Surgery; Article in Press
Quote:
Background
The aim of this study was to ascertain the technical difficulties and complications of video-assisted thoracic sympathectomy (VTAS) in the treatment of hyperhidrosis in a large group of patients.

Methods
Between October 1995 and February 2008, 1731 patients with palmar, axillary, or craniofacial hyperhidrosis, who were treated using bilateral VTAS, were studied. We assessed the technical difficulties, early and late complications, and the approaches that were used to resolve them.

Results
Therapeutic success was achieved in 91% of the cases as evidenced by anhidrosis. The most common and severe technical difficulty during the procedure was pleural adhesions in 116 cases (6.7%); azygos lobes were seen in 7 patients (0.4%) and apical blebs in 3 patients (0.2%). The most frequent postoperative immediate complication was postoperative pain in 1685 (97.4%) patients; pneumothorax with chest drainage was seen in 60 cases (3.5%), neurologic disorders involving the upper limbs in 36 cases (2.1%), Horner’s syndrome in 11 cases (0.9%), significant bleeding in 8 cases (0.4%), and 1 patient had extensive subcutaneous emphysema. The most frequent late complication was compensatory hyperhidrosis, which occurred in 1531 cases (88.4%). Although 27.2% of the patients reported severe compensatory hyperhidrosis, only 2.5% expressed regret for undergoing surgery. Gustatory sweating occurred in 334 patients (19.3%). No deaths occurred in this series.

Conclusions
VTAS is safe and has shown good results. The major complication is compensatory hyperhidrosis and, when severe, the patient may express regret for undergoing surgery. Improvements in instrumentation, adequate training, and careful patient selection may help to reduce the number of drawbacks associated with VTAS.
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Old 12th April 2013, 05:36 PM
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Default Re: Lumbar sympathectomy for plantar hyperhidrosis

Objective evaluation of plantar hyperhidrosis after sympathectomy
Nelson Wolosker, Augusto Ishy, Guilherme Yazbek, José Ribas Milanez de Campos, Paulo Kauffman, Pedro Puech-Leão, and Fábio Biscegli Jatene
Clinics (Sao Paulo). 2013 March; 68(3): 311–315.
Quote:
OBJECTIVE:
The aim of the present study was to prospectively, randomly, blindly, and objectively investigate how surgery affects plantar sudoresis in patients with palmar and plantar hyperhidrosis over a one-year period using a sudorometer (VapoMeter).

METHODS:
From February 2007 to May 2009, 40 consecutive patients with combined palmar hyperhidrosis and plantar hyperhidrosis underwent video-assisted thoracic sympathectomy at the T3 or T4 ganglion level (15 women and 25 men, with a mean age of 25 years).

RESULTS:
Immediately after the operation and during the one-year follow-up, all of the patients were free from palmar hyperhidrosis episodes. Compensatory hyperhidrosis of varying degrees was observed in 35 (87.5%) patients after one year. Only two (2.5%) patients suffered from severe compensatory hyperhidrosis. There was a large initial improvement in plantar hyperhidrosis in 46.25% of the cases, followed by a progressive regression of that improvement, such that only 30% continued to show this improvement after one year. The proportion of patients whose condition worsened increased progressively (from 21.25% to 47.50%), and the proportion of stable patients decreased (32.5% to 22.50%). This was not related to resection level; however, a lower intensity of plantar hyperhidrosis prior to sympathectomy correlated with worse evolution.

CONCLUSION:
Patients with palmar hyperhidrosis and plantar hyperhidrosis who underwent video-assisted thoracic sympathectomy to treat their palmar hyperhidrosis exhibited good initial improvement in plantar hyperhidrosis, which then decreased to lesser degrees of improvement over a one-year period following the surgery. For this reason, video-assisted thoracic sympathectomy should not be performed when only plantar hyperhidrosis is present.

Last edited by NewsBot : 15th January 2014 at 04:29 PM.
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Old 31st July 2013, 04:15 PM
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Default Re: Lumbar sympathectomy for plantar hyperhidrosis

Severe Plantar Hyperhidrosis: An Effective Surgical Solution
Reisfeld, Rafael; Pasternack, Glenn A.; Daniels, Parviz D.; Basseri, Eraj; Nishi, Gregg K.; Berliner, Karen I.
The American Surgeon, Volume 79, Number 8, August 2013 , pp. 845-853(9)
Quote:
Severe palmoplantar hyperhidrosis both affects activities of daily living and diminishes quality of life. This study evaluated overall safety and efficacy of endoscopic lumbar sympathectomy (ELS) using a clamping method in a large series of consecutive patients. Patient data were routinely entered into a prospectively designed database. Plantar sweating was graded as cured, improved, or unchanged. ELS (using 5-mm titanium clips) was performed in 154 patients, 68.2 per cent at the third lumbar vertebrae and 31.8 per cent at the fourth lumbar vertebrae. Follow-up averaged 15 months and ranged up to 4.7 years. Anhidrosis was achieved in 97.4 per cent of patients with the remainder reporting major reduction in symptoms. All patients were discharged home within 24 hours of surgery, requiring only oral analgesics, if any. There were two surgical complications (lymphatic leak and misidentification of genitofemoral nerve for sympathetic nerve). Six early patients required conversion to an open surgical procedure. Partial recurrence, usually mild, occurred in 4.5 per cent with 2.6 per cent requiring revision surgery. Severe plantar hyperhidrosis can be safely and effectively treated by endoscopic lumbar sympathectomy using the clamping method. It can be accomplished on an outpatient basis with low morbidity, complete resolution of symptoms, and a significant improvement in quality of life.
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Old 7th December 2013, 12:26 AM
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Default Re: Lumbar sympathectomy for plantar hyperhidrosis

Impact of transthoracic endoscopic sympathectomy on plantar hyperidosis.
Panagiotis Paliogiannis, Fabrizio Scognamillo, Federico Attene, Carlo Pala, Antonio Marrosu,
Fabio Pulighe, Mario Trignano
Ann. Ital. Chir. 28 July 2013
Quote:
INTRODUCTION: The aim of this study is to evaluate the impact of transthoracic endoscopic sympathectomy on plantar
hyperhidrosis in patients operated on for upper limb hyperhidrosis.
MATERIALS AND METHODS: From 2003 to 2011, 41 consecutive patients underwent videothoracoscopic T3-T4 sympathicotomy
or T3-T4 ganglion block at our Unit for upper limb hyperhidrosis. Twenty-one (51%) were affected by palmar
hyperhidrosis and 20 (49%) by palmar and axillary hyperhidrosis combined. The patients affected by the plantar
form were 26 (63%). Clinical follow-up was performed at 3, 6 and 12 months after surgery. Phone interviews and/or
clinical assessment were made after a variable period of time (range 6 months to 8 years) to asses long term results.
RESULTS: Plantar hyperhidrosis improved in 14 patients, which represents the 54% of the sufferers and the 34% of all
patients. It was partially regressed in 11 patients (79%) and resolved in 3 cases (21%). There were not significant differences
between patients treated with sympathicotomy and those treated with ganglian block.
CONCLUSIONS: Transthoracic endoscopic sympathectomy performed through T3-T4 sympathicotomy or ganglion block
improves plantar hyperhidrosis in approximately 54% of the affected patients, with a partial and complete resolution
rate of 79% and 21% respectively.
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Old 16th February 2014, 01:36 AM
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Default Re: Lumbar sympathectomy for plantar hyperhidrosis

Satisfaction and compensatory hyperhidrosis rates 5 years and longer after video-assisted thoracoscopic sympathotomy for hyperhidrosis.
Bryant AS, Cerfolio RJ.
J Thorac Cardiovasc Surg. 2014 Jan 2.
Quote:
OBJECTIVE:
The objective of the present study was to determine the long-term fate and factors of compensatory hyperhidrosis (CH) in patients who have undergone video-assisted thoracoscopic sympathotomy for focal hyperhidrosis.
METHODS:
The same quality-of-life survey was administered 6 months postoperatively and then annually to all patients who underwent Video-assisted thoracoscopic sympathotomy for hyperhidrosis. A second rib (R2)/R3 sympathotomy was most commonly performed until September 2007 and then R4/R5 sympathotomy was used.
RESULTS:
From January 1999 until December 2012, 193 patients underwent Video-assisted thoracoscopic sympathotomy for hyperhidrosis, of whom, 173 had provided ≥1 year of postoperative survey information. No operative mortalities occurred. Of the 173 patients, 133 (77%) reported "clinically bothersome" CH. This rate had decreased to an average of 35% at 5 and 12 years postoperatively. Univariate analysis showed the CH incidence was significantly greater for the patients who had undergone R2/R3 versus R4/R5 sympathotomy (P < .001), had had multiple sites of sweating at presentation (P < .001), had used oral medication to control hyperhidrosis preoperatively (P = .022), or were female (P = .002). On multivariate analysis, only R2/R3 versus R4/R5 sympathotomy (P < .021) and multiple sites of sweating at presentation (P < .037) remained statistically significant. Twelve patients (6.2%) regretted having the operation for CH.
CONCLUSIONS:
Patients who undergo sympathotomy for hyperhidrosis will commonly report "clinically bothersome" compensatory hyperhidrosis. CH will more likely if R2/R3 sympathetic interruption has been performed instead of R4/R5 and in patients who present with multiple areas of sweating. The severity of clinically bothersome CH decreased during the first 3 years postoperatively.
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Old 9th November 2014, 01:35 PM
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Default Re: Lumbar sympathectomy for plantar hyperhidrosis

3-Year Follow-Up After Uniportal Thoracoscopic Sympathicotomy for Hyperhidrosis: Undesirable Side Effects
Karamustafaoglu Yekta Altemur, Kuzucuoglu Mustafa, Yanik Fazlı, Sagiroglu Gonul, and Yoruk Yener.
Journal of Laparoendoscopic & Advanced Surgical Techniques. November 2014, 24(11): 782-785.
Quote:
Objective: Endoscopic thoracic sympathectomy or sympathicotomy, for the treatment of palmar, axillary, and plantar hyperhidrosis, is generally performed at one or two levels, between T2 and T5. Compensatory sweating (CS) is a severe and undesirable side effect of this procedure. Here, we describe the success of treatment and degree of postoperative CS in sympathicotomy patients.

Subjects and Methods: This study included 80 patients treated by uniportal (5-mm) thoracoscopic sympathicotomy (electrocautery) for primary hyperhidrosis over a 6-year period (2007–2013). Sympathicotomy was performed bilaterally at T2 for blushing (n=2), T2–T3 for palmar-only hyperhidrosis (n=34), T2–T4 for palmar and axillary hyperhidrosis (n=39), and T3–T4 for axillary-only hyperhidrosis (n=5). Outcome was assessed 2 weeks postsurgery at the clinic and annually thereafter by telephone questionnaire. Mean follow-up time was 35.2±23.3 months. Questionnaires assessed patients' degree of sweating, postoperative CS, overall satisfaction, and complications.

Results: Seventy-one patients (88.7%) were very satisfied, whereas only 9 (11.3%) were dissatisfied with the procedure. Complication incidence was 7.5%, and CS occurred in 77.5% of patients. Therapeutic success rate was 97.5%; complete relief of hyperhidrosis was achieved in 72 (90%) patients, whereas 8 (10%) experienced recurrence.

Conclusions: CS is a frequent side effect of thoracoscopic sympathicotomy. We recommend all patients undergoing this procedure should be warned of the potential risk of developing severe CS.
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Old 22nd November 2014, 03:14 PM
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Default Re: Lumbar sympathectomy for plantar hyperhidrosis

Quality of life after sympathetic surgery at the T4 ganglion for primary hyperhidrosis: Clip application versus diathermic cut
Peter Panhofer, Claudia Ringhofer, Andreas Gleiss, Raimund Jakesz, Manfred Prager, Georg Bischof, Christoph Neumayer
International Journal of Surgery; 18 November 2014
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Highlights
•Sympathectomy – good outcome.
•Cut – severe compensatory sweating.
•Clip – recurrence rates.
Quote:
Introduction: Limited procedures at the T4 ganglion show low rates of compensatory sweating (CS). The aim of the study was to compare endoscopic sympathetic block (ESB) via clip application with endothoracic sympathicotomy (ETS) via diathermy with special regard on patients' quality of life (Qol).
Patients and methods: Treatment success, side effects and patient satisfaction were evaluated in a prospectively gathered database of a tertiary-care referral hospital. Two disease-specific Qol questionnaires were used (Keller, Milanez de Campos).
Results: 406 operations were performed in 205 patients (ESB4 N = 114, ETS4 N = 91) with a median follow-up of 12 months. Both procedures improved Qol significantly (P < 0.001) and the degree of improvement was equal in both groups. Palmar and axillary HH were ameliorated after both procedures (P < 0.001). Accordingly, plantar HH decreased after ESB4 (P = 0.002), while remaining unaltered after ETS4. Nineteen patients (9.3%) reported CS and 10 patients (4.9%) judged it as “disturbing”. Nine of the latter belonged to the ETS4 group compared to one ESB patient (P = 0.015). Patients developed higher rates of plantar CS after ETS4 compared to ESB4 (P = 0.006). Five patients (2.4%) from both cohorts reported persistence of axillary HH. Recurrence of axillary symptoms was found in 5 ESB4 patients. Satisfaction rates did not differ significantly.
Conclusion: Patients' Qol and satisfaction rates are similar in both treatment groups for upper limb HH. Outcome and recurrence rates speak in the favor of ETS4, severity of CS and potential reversibility argue for ESB4.
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Old 10th December 2014, 12:31 AM
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Default Re: Lumbar sympathectomy for plantar hyperhidrosis

Quality of Life After Endoscopic Lumbar Sympathectomy for Primary Plantar Hyperhidrosis
Roman Rieger, Sonja Pedevilla, Johannes Lausecker
World Journal of Surgery; December 2014
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Background
Primary plantar hyperhidrosis is characterised by excessive secretion of the sweat glands of the feet and may lead to significant limitations in private and professional lifestyle. The aim of this prospective study was to assess the effect of endoscopic lumbar sympathectomy (ESL) on the quality of life (QL) of patients with primary plantar hyperhidrosis.
Methods
Bilateral ESL was performed on 52 patients, 31 men and 21 women with primary plantar hyperhidrosis. Perioperative morbidity and clinical results were evaluated in all patients after a mean follow-up of 15 months. Postoperative QL was examined with the SF-36V2 questionnaire and the hyperhidrosis-specific questionnaires devised by Milanez de Campos and Keller.
Results
All procedures were carried out endoscopically with no perioperative morbidity. Plantar hyperhidrosis was eliminated in 50 patients (96 %) and two patients (4 %) suffered a relapse. Unwanted side effects occurred in the form of compensatory sweating in 34 (65 %) and in the form of postsympathectomy neuralgia in 19 patients (37 %). Ninety six percentage of patients were satisfied with the postoperative result and 88 % would have the surgery repeated. The SF-36V2 questionnaire revealed a significant improvement of QL after lumbar sympathectomy in physical health (physical component summary, p < 0.01) as well as mental health (mental component summary, p < 0.05). Improved QL was also demonstrated in the Milanez de Campos questionnaire in the dimensions functionality/social interactions (p < 0.01), intimacy (p < 0.01), emotionality (p < 0.01) and specific circumstances (p < 0.01) as well as in the Keller questionnaire in the area of plantar hyperhidrosis (p < 0.01).
Conclusion
The performance of an ESL in patients with primary plantar hyperhidrosis leads to the effective elimination of excessive sweat secretion of the feet and to an increase in QL.
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Old 4th May 2015, 07:55 PM
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Default Re: Lumbar sympathectomy for plantar hyperhidrosis

Thoracoscopic Sympathicotomy for Treatment of Hyperhidrosis
Karamollah Toolabi; Hamid Ahmadi; Fezzeh Elyasinia; and Reza Parsaei
Jundishapur Journal of Chronic Disease Care. 2015 July; 2(3): e19514 ,
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Background: Approximately, 3% of the world’s population have hyperhidrosis, a situation in which excessive sweating occurs in response to the need to regulate body temperature. Endoscopic devices have been used for treatment of this disease through sympathicotomy.

Objectives: The aim of this study was to assess the effectiveness and adverse effects of endoscopic sympathicotomy in treatment of hyperhidrosis.

Patients and Methods: We enrolled 41 patients in the study. Ganglion disconnection was performed at T2 - T3 level for patients with palmar hyperhidrosis and at T3 - T4 level for patients with axillary hyperhidrosis. Patients were evaluated for successful response to surgical treatment, occurrence of reflex hyperhidrosis following surgery, and location of reflex hyperhidrosis at one week and at six months of surgery.

Results: After surgical treatment, 75.6% of patients reported complete response to treatment while 82.9% reported reflex hyperhidrosis after surgery. The frequency for moderate and severe sweating was 8.8% and 26.5%, respectively.

Conclusions: Sympathicotomy technique can be used in the treatment of primary hyperhidrosis in patients who did not respond to nonsurgical treatments; however, the incidence of reflex hyperhidrosis is of concern following surgical treatment.
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