Thoracoscopic sympathectomy for hyperhidrosis: analysis of 642 procedures with special attention to Horner's syndrome and compensatory hyperhidrosis.

Abstract

BACKGROUND:

Hyperhidrosis (HH) profoundly affects a patient's well-being.

OBJECTIVE:

We report indications and outcomes of 322 patients treated for HH via thoracoscopic sympathectomy or sympathotomy at the Barrow Neurological Institute.

METHODS:

A prospectively maintained database of all patients who underwent sympathectomy or sympathotomy between 1996 and 2008 was examined. Additional follow-up was obtained in clinic, by phone, or by written questionnaire.

RESULTS:

A total of 322 patients (218 female patients) had thoracoscopic treatment (mean age 27.6 years; range, 10-60 years). Mean follow-up was 8 months. Presentations included HH of the palms (43 patients, 13.4%), axillae (13 patients, 4.0%), craniofacial region (4 patients, 1.2%), or some combination (262 patients, 81.4%). Sympathectomy and sympathotomy were equally effective in relieving HH. Palmar HH resolved in 99.7% of patients. Axillary or craniofacial HH resolved or improved in 89.1% and 100% of cases, respectively. Hospital stay averaged 0.5 days. Ablating the sympathetic chain at T5 increased the incidence of severe compensatory sweating (P = .0078). Sympathectomy was associated with a significantly higher incidence of Horner's syndrome compared with sympathotomy (5% vs 0.9%, P = .0319). Patients reported satisfaction and willingness to undergo the procedure again in 98.1% of cases.

CONCLUSION:

Thoracoscopic sympathectomy is effective and safe treatment for severe palmar, axillary, and craniofacial HH. Ablating the T5 ganglion tends to increase the severity of compensatory sweating. Sympathectomy led to a higher incidence of ipsilateral Horner's syndrome compared with sympathotomy.

• Authors: Scott D Wait, Brendan D Killory, Gregory P Lekovic, Francisco A Ponce, Kathy J Kenny, Curtis A Dickman
• Journal: Neurosurgery (Neurosurgery) Vol. 67 Issue 3 Pg. 652-6; discussion 656-7 (Sep 2010) ISSN: 1524-4040 [Electronic] United States
• PMID: 20647968 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Child
• Female
• Ganglia, Sympathetic (physiopathology, surgery)
• Ganglionectomy (methods)
• Horner Syndrome (epidemiology, physiopathology, prevention & control)
• Humans
• Hyperhidrosis (pathology, physiopathology, surgery)
• Male
• Middle Aged
• Prospective Studies
• Sympathectomy (methods)
• Thoracoscopy (methods)
• Young Adult