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PubMed2002

Botulinum toxin A in anal fissures: a modified technique.

BACKGROUND: Anal fissures are common and painful. Botulinum toxin A (BTXA) is considered to be the most potent non-surgical treatment; however, no attention has been paid to associated hyperhidrosis. AIM: To compare traditional BTXA treatment of muscular spasticity in anal fissures with combined treatment of spasticity and focal hyperhidrosis of the anal fold and perianal skin. SETTING: Outpatient department of a dermatological hospital. PATIENTS AND METHODS: Ten patients with chronic anal fissures (of more than 6 months duration who failed to respond to conservative treatment and who had refused surgery) associated with focal hyperhidrosis as assessed by Minor's sweat test were investigated in an open, two-armed trial. Intramuscular injections of 20-25 U BTXA (Botox) were performed in group A (n = 5). In group B (n = 5) those injections were combined with intracutaneous injection of 30-50 U BTXA to treat focal hyperhidrosis. Mean follow-up was 5 months. RESULTS: Five of five patients in group B but only two of five patients in group A experienced a complete remission despite the fact that relief of pain was evident in eight of 10 patients within 2 weeks. Patient satisfaction with treatment was high but slightly better in group B. CONCLUSIONS: This open trial suggests that combined therapy of both muscular spasticity and focal hyperhidrosis may provide better results than intramuscular injections alone in anal fissure therapy with BTXA.

Adult↗
PubMed1999

[Video-assisted thoracosopic sympathectomy: spectrum of indications and our own results (1995-1997)].

INTRODUCTION: Video-assisted thoracoscopic (VATS) sympathectomy is the most frequently used technique for surgical sympathectomy of the upper limbs. It has proven to be particularly effective in hyperhidrosis of the hands. The aim of this study is to review and discuss possible indications and analyse our own results from 1995 to 1997, including technical details on the use of a new 2-mm thoracoscope and instrumentation. PATIENTS AND METHODS: Data of all 14 consecutive patients were prospectively assessed (8 females, 6 males, mean age 44 years; range 22-74 years). A total of 26 thoracoscopic sympathectomies were performed. Indications included: 7 cases of hyperhidrosis, 4 of inoperable and medically intractable angina pectoris, 3 of vascular diseases of the upper extremity. All patients were reexamined 3 months postoperatively and late follow-up was obtained in all patients, with a mean follow-up of 20 months postoperatively (4-36 months) by questionnaire. RESULTS: 22 Th2-Th5 and 4 Th2-Th4 resections of the sympathetic chain were performed. There was no conversion to open surgery. The mean operating time was 67 minutes (range 50-90 min.). One (3.8%) unilateral Horner syndrome occurred with complete recovery during follow up. Compensatory sweating occurred in 7 (50%). The mean hospitalisation was 4.7 days for all patients and 2.8 days for those with hyperhidrosis. In 10 patients (71.5%), symptoms of the underlying disease had completely ceased on the day of discharge, and in 4 (28.5%) the symptoms had improved. Two months postoperatively a unilateral relapse occurred in one patient with Raynaud's disease. After a mean of 20 months, the quality of life was improved in 12 (85%) and was unchanged as compared to preoperatively in 2 (15%). CONCLUSIONS: Primary hyperhidrosis showed the best results after thoracoscopic sympathectomy. Although experience with angina pectoris is still limited, thoracoscopic sympathectomy seems to be a valuable alternative in otherwise inoperable cases. In upper-extremity vascular diseases the operation can be performed as a last therapeutic option, but relapse often occurs in these patients. 2-mm instrumentation decreases trauma and postoperative pain and improves cosmetic results, which obviously may play a role in younger patients with hyperhidrosis. Patients should be warned about compensatory sweating before thoracic sympathectomy.

Adult↗
PubMed2000

Thoracoscopic sympathectomy.

The objective was to evaluate the safety and effectiveness of endoscopic thoracic sympathectomy (ETS) for treatment of a variety of sympathetic disorders, including hyperhidrosis, splanchnic pain, reflex sympathetic dystrophy, and Raynaud upper extremity ischemia. Sixty-three ETS procedures were performed in 34 patients at the University of Maryland Medical System between March 1992 and August 1999 (14 male patients, 20 female patients; mean age 22 years). The indications for surgery were hyperhidrosis in 26 patients, upper extremity ischemia in 3 patients, splanchnic pain and reflex sympathetic dystrophy in 2 patients each, and facial blushing in 1 patient. Preoperative symptoms resolved completely or improved significantly in 97.1% (33/34) of patients. One patient with left reflex sympathetic dystrophy had symptoms that recurred shortly after surgery. There were no major complications; one patient with hyperhidrosis reported significant compensatory hyperhidrosis. These findings suggest that ETS is a safe and effective procedure for treatment of a variety of sympathetic disorders. Its application for hyperhidrosis is very effective, and its treatment of splanchnic pain, reflex sympathetic dystrophy, and Raynaud syndrome are rewarding. With increasing experience, ETS should become established in the repertoire of the thoracic surgeon.

Abdominal Pain↗
PubMed1992

Efficacy of thoracic sympathetic ganglion block and prediction of complications: clinical evaluation of the anterior paratracheal and posterior paravertebral approaches in 234 patients.

In the 10 years from 1980 to 1989, a total of 234 patients underwent 557 thoracic sympathetic ganglion blocks. The block was performed by the anterior paratracheal approach in 129 cases and by the posterior paravertebral approach in 428 cases. The procedures for using these two approaches are presented here. The efficacy of thoracic sympathetic ganglion blockade was evaluated as follows; marked efficacy was defined by the complete control of sweating in the palms, moderate efficacy was defined by a decrease in palmar sweating which persisted for at least one week, and minor efficacy was defined by a decrease in sweating followed by recurrence of hyperhidrosis within one week with maintenance of palmar warmth. in addition, the results were retrospectively reviewed in relation to the age and sex of the patients, the technique used, the laterality of the block, the disease treated, the doses of local anesthetic and neurolytic agents, and the number of blocks. The posterior approach was significantly more successful than the anterior approach, and the treatment of both T2 and T3 by the posterior approach was significantly more effective than the treatment of either nerve alone by the same approach ( P < 0.01). The efficacy rate was significantly lower for hyperhidrosis than for the other diseases ( P < 0.01). Complete cessation of hyperhidrosis was significantly less common in the over-60 age group ( P < 0.01). Regarding the dose of neurolytic, the complete cessation of hyperhidrosis was achieved significantly more frequently with doses of 2.5 ml or higher than with lower doses ( P < 0.01) when both T2 and T3 wee treated by the posterior approach. A dose-dependent response if hyperhidrosis was noted at dose levels higher than 2.5 ml. Thoracic sympathetic ganglion blockade was only occasionally associated with complications, and no serious complications were observed. Before injecting the neurolytic agent, a mixture of contrast medium and local anesthetic was injected to determine the three-dimensional distribution of the contrast and to assess the scope of the analgesia produced by the local anesthetic. Significant complications could thus be avoided.

Journal Article↗
PubMed2000

Are we paying a high price for surgical sympathectomy? A systematic literature review of late complications.

The purpose of this article was to systematically review the literature in order to assess (1) the current indications for surgical sympathectomy and (2) the incidence of late complications collectively and per indication. All types of upper or lower limb surgical sympathectomies are included. An extensive search strategy looked for controlled trials and observational studies or case series with an english abstract. Out of 1,024 abstracts from MEDLINE and 221 from EMBASE, 135 articles reporting on 22,458 patients and 42,061 procedures (up to april 1998) fulfilled the inclusion criteria. Weighted means were used to control for heterogeneity of data. No controlled trials were found. The main indication was primary hyperhidrosis in 84.3% of the patients. Compensatory hyperhidrosis occurred in 52.3%, gustatory sweating in 32.3%, phantom sweating in 38.6%, and horner's syndrome in 2.4% of patients, respectively, with cervicodorsal sympathectomy, more often after open approach. Neuropathic complications (after cervicodorsal and lumbar sympathectomy) occurred in 11.9% of all patients. Compensatory hyperhidrosis occurred 3 times more often if the indication was palmar hyperhidrosis instead of neuropathic pain (52.3% versus 18.2%), whereas neuropathic complications occurred 3 times more often if the treatment was for neuropathic pain instead of palmar hyperhidrosis (25.2% versus 9.8%). Surgical sympathectomy, irrespective of approach, is accompanied by several potentially disabling complications. Detailed informed consent is recommended when surgical sympathectomy is contemplated.

Journal Article↗
PubMed2003

Disorders of sweating.

The clinical spectrum of sweating disorders includes sudomotor excess and deficiency. Hyperhidrosis is characterized by sweating beyond that required to maintain a constant internal body temperature. Hypohidrosis and anhidrosis are distinguished by a reduced or absent ability to generate sweat for the purpose of evaporative heat dissipation. Whereas hyperhidrosis is usually benign, anhidrosis may predispose to hyperthermia. Either hyperhidrosis or anhidrosis may accompany a more serious underlying disorder. Correct diagnosis depends on determining the anatomical pattern of sweating and localizing the lesion within the autonomic nervous system. Sudomotor deficits may involve the frontal operculum, hypothalamus, brain stem, spinal cord, sympathetic chain ganglia, peripheral nerve, or eccrine sweat glands. Treatments for hyperhidrosis include topical aluminum chloride, oral anticholinergic agents, intradermal botulinum toxin for some localized syndromes, and thoracic ganglionic sympathotomy or sympathectomy for refractory palmar hyperhidrosis.

Animals↗
PubMed2004

Botulinum toxin treatment of secretory disorders.

Botulinum neurotoxin serotype A (BoNT/A) has revolutionised the treatment of a variety of autonomic hypersecretory disorders. Several open and controlled studies indicate that BoNT/A is a safe and effective treatment for focal hyperhidrosis of the axillae and palms, for gustatory sweating, and for some other rare conditions associated with focal hyperhidrosis. There is class I evidence for the efficacy of botulinum toxin in axillary hyperhidrosis and class II evidence for palmar hyperhidrosis and gustatory sweating. BoNT/A has the potential to replace current invasive and surgical techniques and should at least be considered as a viable alternative. The results of pilot studies to treat sialorrhea are encouraging. However, the optimal dose, best mode of application, side effects, and duration of BoNT/A action in this condition remain uncertain. We need further formal clinical trials to evaluate risks and benefits of BoNT/A for palliative treatment in of sialorrhea in Parkinson's disease and in bulbar amyotrophic lateral sclerosis. Based on the few reports published, BoNT/A injections into the lacrimal gland for hyperlacrimation may be an elegant method to treat this sometimes disabling condition. Again, larger studies are needed to evaluate the risks and long-term benefits of this treatment option.

Anti-Dyskinesia Agents↗
PubMed2001

Skin function and skin disorders in Parkinson's disease.

Cutaneous symptoms (seborrhoea and hyperhidrosis) in Parkinson's disease were investigated. In 70 treated patients with Parkinson's disease and 22 control subjects, non-invasive bioengineering methods (sebumetry, corneometry, pH) were carried out on the forehead, sternum and forearm. In addition, concomitant dermatoses and medication were recorded. 18.6% of the patients had seborrhoea on the forehead (>220 microg/cm2), 51.4% showed normal sebum values (100-220 microg/cm2) and 30% a sebostasis (<100 microg/cm2). Males has significantly higher sebum values than females. No relationship between the seborrhoea and the therapy for Morbus Parkinson was found. Patients with hyperhidrosis (n = 36) had significantly lower pH values (p < 0.05) on the forehead than those without hyperhidrosis. 22 patients (31.9%) reported a cold/hot flush and a further 13 (18.8%) had clinical rosacea. Seborrhoea is rare in treated Parkinsonian patients but hyperhidrosis is frequently found. Furthermore, a particular lack of vasostability (flush) appears to be an autonomic dysregulation in the skin related to Morbus Parkinson, which has not been studied to any extent to date.

Aged↗
PubMed2004

[Compensatory sweating after upper thoracic sympathectomy. Prospective study of 123 cases].

OBJECTIVE: The most unpleasant consequence of upper thoracic sympathectomy is compensatory sweating (CS). De-pending on the series, the incidence of CS ranges from 24% to 85%. The aim of this study was to determine the relation between CS and the following factors: distribution of hyperhidrosis, procedure performed (unilateral, synchronic bilateral, or sequential bilateral), and number of sympathetic ganglia eliminated. In addition, the degree of patient satisfaction was recorded as objectively as possible. PATIENTS AND METHODS: Prospective study of 123 patients who underwent upper thoracic sympathectomy for palmar and/or axillary hyperhidrosis between 1 January, 1996 and 1 June, 2002 at our unit. All patients completed a questionnaire on symptoms 8 weeks before and after surgery to deter-mine postoperative changes in distribution of the hyperhidrosis and the overall degree of satisfaction on a scale of 0 to 4. RESULTS: The sensation of CS was reported by 86.1% of the patients. When asked to relate this sensation to changes in sweating intensity in specific parts of the body, 46.54% reported CS and 48.37% no change. The trunk was the only region where statistically significant increases in CS occurred; in the feet, a decrease in sweating was noted. No differences in CS were observed with respect to the type of surgery or the number of sympathetic ganglia eliminated. The overall results were considered very satisfactory or quite satisfactory by 84.55% of the patients, while 4.88% were very dissatisfied. CONCLUSIONS: Although CS is a side effect of upper thoracic sympathectomy, not all patients are affected by it. Significant CS occurs mainly in the back, chest, and abdomen. Neither the type of intervention nor the number of ganglia eliminated has an effect on CS. This side effect notwithstanding, overall satisfaction with the treatment is very satisfactory given that the palmar hyperhidrosis is eliminated.

Adolescent↗
PubMed2001

Ultrastructure of the hyperhidrotic eccrine sweat gland.

BACKGROUND: Hyperhidrosis is the secretion of inappropriately large amounts of sweat by eccrine glands; it can be very debilitating. Little is known of the causes of primary hyperhidrosis. OBJECTIVES: To determine whether the glands exhibit any structural abnormality in primary hyperhidrosis. METHODS: Skin biopsies were obtained from the axilla (n = 6) or neck (n = 2) of individuals aged 26-62 years with primary hyperhidrosis and from five age- and sex-matched normal individuals, with informed consent and ethical committee approval. Samples were prepared by standard methods for light and electron microscopic examination. RESULTS: All characteristics observed in the hyperhidrotic specimens were consistent with the changes seen in normal glands following strong activation: degranulation of the granular (dark) cells, dilatation of the basolateral infoldings and the canaliculi of the non-granular (clear) cells, contraction of the myoepithelial cells and thickening of the basal lamina, and presence of cellular debris including lipid droplets in the gland lumen. Pathological changes were not observed. CONCLUSIONS: The present finding of the absence of structural defects in the glands indicates that future studies should concentrate on the investigation of neurohumoral or secretory cell metabolic abnormalities.

Adult↗
PubMed2000

[The indications for and results of video thoracoscopic sympathectomy].

BACKGROUND AND OBJECTIVES: Thoracoscopic sympathectomy, for years an effective way to treat mainly palmar and axilla hyperhidrosis, experienced a revival since the application of the principles of minimally invasive surgery. We report the personal experiences of three surgeons with this technique, as well as patients' view of the outcome. PATIENTS AND METHODS: Between January 1990 and November 1997, 73 procedures were performed in 43 patients (23 males, 20 females, mean age 38.1 years, range 15-82 years), and the outcome was prospectively studied. Palmar hyperhidrosis without axilla symptoms was the indication for the operation in 27 patients (54 sympathectomies), Raynaud's syndrome in 15 (18 sympathectomies), and causalgia in one. Thoracic ganglia 2-4 were always completely resected. Perioperative morbidity as well as patient satisfaction in the long-term course (standardized interview) 25.8 (1-77) months postoperatively were assessed. RESULTS: The complication rate in all 73 sympathectomies was 8.2%. Only two severe incidents were observed: in one patient intermittent Horner's syndrome (1.4%) occurred, and in another severe bleeding required conversion to open surgery (1.4%). Both complications occurred in the early study phase. The initial success rate in all 27 patients with hyperhidrosis was 100%. In 30% of these cases a mild partial relapse was observed, which did not interfere with their daily activities. 53% of the patients reported compensatory and 23% gustatory sweating. 9% would have refused the operation, had they known these side effects. In all patients with Raynaud's disease the ulcerations healed completely. At the time of the interview, two patients (13%) complained of painless relapses. They too stated that they had refused the operation, if they had known about the relapses. CONCLUSIONS: Even in the longer-term course, thoracoscopic sympathectomy is rated subjectively successful by 93% of patients after treatment of hyperhidrosis of the upper extremities, and by 87% of patients after treatment of Raynaud's disease, despite some untoward effects and partial relapses.

Adolescent↗
PubMedDate not supplied

Comparison of sympathetic skin response between palmar hyperhidrotic and normal subjects.

Palmar hyperhidrosis is a disorder with excessive sweating. The purpose of this study is to evaluate the autonomic function in palmarhyperhidrotic patients with Sympathetic skin response (SSR) test. In this study SSr was performed for the upper limbs of 20 patients with palmar hyperhidrosis, who did not have any other systemic or localized wrist and palmar disease as "Involved Group" and 28 healthy subject as "Control Group" without any palmar hyperhidrosis, systemic or local disease. The findings indicated a significant difference between latency and amplitude of the two groups (P.V. < 0.001) 95%. Beside, in this study, we observed a direct correlation between severity of symptom and the degree of SSR abnormality. Therefore, involvement of sympathetic nervous system in palmar hyperhidrosis were highly suspected.

Adult↗
PubMed2004

Thoracoscopic sympathectomy in the management of vasomotor disturbances and complex regional pain syndrome of the hand.

Complex regional pain syndrome, vasospastic disorders, and hyperhidrosis are chronic and debilitating upper extremity problems. Twenty-nine consecutive patients treated with thoracoscopic sympathectomy are presented. Diagnoses included complex regional pain syndrome, hyperhidrosis, Buerger's disease, Raynaud's disease, and peripheral vascular disease. All patients with hyperhidrosis had complete symptom resolution. Patients with Buerger's and Raynaud's disease had excellent/good results. Six patients with complex regional pain syndrome had excellent or good relief; the remaining six patients had varying degrees of recurrence. A statistically significant association was noted between duration of complex regional pain syndrome prior to sympathectomy and outcome. Thoracoscopic sympathectomy is an effective treatment for hyperhidrosis and vasospastic disorders. Although the results for complex regional pain syndrome are not uniformly excellent, this technique offers promise in the treatment of this difficult problem.

Adolescent↗
PubMed1996

Technical considerations in endoscopic cervicothoracic sympathectomy.

OBJECTIVE: To evaluate the technique and results of videoendoscopic cervicothoracic sympathectomy in patients who have reflex sympathetic dystrophy or hyperhidrosis of the upper extremity. DESIGN: Clinical case series. The cohort underwent diagnostic evaluation and surgical intervention, and had a mean postoperative follow-up of 14 months. SETTING: An urban, university-affiliated tertiary referral medical center. PATIENTS: A consecutive, referred sample. Seven of the nine patients had reflex sympathetic dystrophy and two had bilateral upper extremity hyperhidrosis. Five were women and four were men, with a mean age of 44 years. INTERVENTIONS: Ten thoracoscopic sympathectomies, encompassing the lower third of the stellate ganglion to the fourth thoracic ganglion, in nine patients. The technique is performed under general anesthesia, using three 1-cm incisions for instrument placement. Patients had bilateral hand temperature probes intraoperatively. Six of the procedures were in the left hemithorax, four in the right. MAIN OUTCOME MEASURES: Relief of the symptoms for which the patient was referred. Perfection and alteration of the technique also were measured. RESULTS: The average operating time was 91 minutes. The average length of hospital stay was 3.5 days. The mean increase in skin temperature was 2.4 degrees C. Nine of 10 patients had partial or complete relief of symptoms. One patient with severe dystrophic reflex sympathetic dystrophy has persistent symptoms. One patient had a pneumothorax for 48 hours. Horner's syndrome did not develop in any patient. CONCLUSION: Endoscopic cervicothoracic sympathectomy is an effective, minimally invasive therapy for upper extremity reflex sympathetic dystrophy and hyperhidrosis.

Adult↗
PubMed1998

Vasomotor and sudomotor function in the hand after thoracoscopic transection of the sympathetic chain: implications for choice of therapeutic strategy.

The degree of sympatholysis achieved by thoracoscopic transection of the sympathetic chain (sympathicotomy) was evaluated by measuring sudo- and vasomotor function in the hands before and after surgery in 12 patients with palmar hyperhidrosis. Our results show a marked reduction in sweat production and a cutaneous vasodilatation which remained unchanged during the 6 months follow-up, whereas sudo- and vasomotor reflexes normalized within this time. Skin temperature variations did not correlate to skin perfusion changes. Since all subjects reported dry and warm hands throughout the follow-up period, our results indicate that recording reflex responses to sympathoexcitatory stimuli does not adequately reflect clinical outcome of subtotal sympatholytic procedures performed for hyperhidrosis. Monitoring of clinical outcome should therefore include measurement of baseline sweat production and skin perfusion. However, the normalized reflex responses highlight the incomplete sympatholysis achieved by thoracoscopic sympathicotomy, which may be beneficial in some pathological conditions (such as hyperhidrosis) but detrimental in others.

Adrenergic Fibers↗
PubMed2002

Endoscopic transthoracic sympathicotomy and peripheral microcirculation: effects of electric sympathetic chain stimulation, thermocoagulation and anaesthetic agents.

BACKGROUND: During endoscopic transthoracic sympathicotomy (ETS) in patients with hyperhidrosis it is useful to assess the effect of surgery peroperatively. However, the autonomic system is affected in various ways by different anesthetic agents. In the present study, the effect of ETS during either isoflurane or propofol anesthesia was evaluated by measuring changes in the finger pulp microcirculation using laser Doppler flowmetry (LDF). Electric stimulation of the sympathetic chain was used for identifying the sympathetic chain and to explore whether the anesthetic agents differentially influenced the LDF response to stimulation. METHODS: From a group of 12 patients with incapacitating palmar hyperhidrosis, six were randomly assigned to isoflurane and six to propofol anesthesia. LDF probes were attached to the ipsilateral finger pulp for continuous recording of peripheral blood flow during the ETS procedure. Electric stimulation (1 Hz, 10 Hz, and 100 Hz) was applied to the sympathetic paravertebral chain at the levels of the 2nd and 3rd sympathetic ganglia via a custom designed bipolar electrode. In eight of the patients LDF recordings were also performed in the awake state and compared with records obtained from eight healthy subjects. FINDINGS: In patients anesthetized with isoflurane, the base line finger pulp blood flow did not significantly differ from that of awake normal subjects, while those anesthetized with propofol had a lower base line flow, similar to that of awake subjects with hyperhidrosis. Stimulation of the sympathetic chain induced marked reduction of finger pulp microcirculation in both anesthetic groups, and this effect was frequency dependent during isoflurane anesthesia. After ETS a significant increase in flow was recorded only in the propofol group. Interpretation. The study demonstrates that the completeness of the sympathicotomy can only be peroperatively evaluated if an anesthetic agent with relatively low vasodilatory capacity, as e.g. propofol, is utilized.

Adult↗
PubMed2005

The body mass index and level of resection: predictive factors for compensatory sweating after sympathectomy.

OBJECTIVE: Compensatory sweating (CS) is the most common adverse event and the main cause of dissatisfaction among patients undergoing a VATS sympathectomy for the treatment of primary hyperhidrosis. It has been described that obese individuals experience more sweating than thinner ones. The aim of this study is to identify the Body Mass Index (BMI) and the level of resection as predictive factors for CS and its relation to levels of patient satisfaction following the procedure. METHODS: From October 1998 to June 2003, 102 patients undergoing VATS sympathectomies (51 for palmar hyperhidrosis, PH, and 51 for axillary hyperhidrosis, AH) were prospectively surveyed. They were divided into three groups according to their BMI: Group I was composed of 19 patients with BMI<20 (9 patients with PH and 10 with AH); Group II was composed of 52 patients with 20 < or =BMI<25 (25 with PH and 27 with AH); and Group III was composed of 31 patients with BMI > or =25 (17 with PH and 14 with AH). Each procedure was simultaneously and bilaterally performed under general anesthesia using two 5.5 mm trocars and a 30 degrees optic system. RESULTS: Patients treated for PH (resection of T2-T3) had more severe CS than those with AH (resection of T3-T4) (p=0.007) and the greater the BMI, the greater the severity of the CS (p<0.001). No statistically significant difference was found between the BMI bands in relation to the degree of satisfaction (p=0.644), nor when we compared the degree of satisfaction to the degree of CS (p=0.316). CONCLUSIONS: The greater the BMI, the more severe the CS, but this did not correlate with the patients' level of satisfaction. Avoiding the resection of T2 sympathetic ganglia is also important in reducing the intensity of CS.

Adolescent↗
PubMed2005

Clinical experience in 397 consecutive thoracoscopic sympathectomies.

BACKGROUND: The purpose of this study is to evaluate the safety and efficacy of thoracoscopic sympathectomy for the treatment of hyperhidrosis, blushing, reflex sympathetic dystrophy, and digital ischemia. METHODS: We conducted a retrospective review of 202 patients who underwent thoracoscopic sympathectomy at the University of Maryland from March 1992 to April 2003. RESULTS: Three hundred ninety-seven procedures were performed on 202 patients (105 women, 97 men). Mean age was 29 years (range, 9 to 65). Indications for surgery included hyperhidrosis, facial blushing, digital ischemia, and reflex sympathetic dystrophy. Synchronous bilateral sympathectomies were performed in 194 patients; right side alone (n = 6); left side alone (n = 1); 1 patient had staged bilateral sympathectomies. Single incision with lung isolation technique was used. There was no mortality. Preoperative symptoms resolved completely or significantly improved in greater than 90% of patients. One patient with reflex sympathetic dystrophy recurred and 1 patient with hyperhidrosis complained of significant compensatory sweating. Compensatory sweating to a lesser degree occurred in approximately one third of patients. Complications included asymptomatic pleural effusion (n = 1), pneumothorax (n = 1), and reoperation for chylothorax that was identified early (n = 1). In 2 patients treated for facial blushing, Horner's syndrome developed postoperatively; 1 of them subsequently underwent blepharoplasty. In 3 patients, hyperesthesias developed at the incision. CONCLUSIONS: Thoracoscopic sympathectomy can be performed safely and with excellent results. Compensatory sweating is the main side effect, although significant complaints from this are rare. Horner's syndrome remains an extremely uncommon complication as a result of thoracoscopic sympathectomy at our institution.

Adolescent↗