Advertisement

Long-Term Efficacy of T3 Versus T3+T4 Thoracoscopic Sympathectomy for Concurrent Palmar and Plantar Hyperhidrosis

  • Author Footnotes
    1 These authors contributed equally to this work.
    Chenglin Yang
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China

    Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.
    Zifan Li
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
    Search for articles by this author
  • Huiwen Bai
    Affiliations
    Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
    Search for articles by this author
  • Hailong Mao
    Affiliations
    Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
    Search for articles by this author
  • Jie Xiong Li
    Affiliations
    Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
    Search for articles by this author
  • Hao Wu
    Affiliations
    Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
    Search for articles by this author
  • Da Wu
    Correspondence
    Corresponding author. Department of Thoracic Surgery, Peking University Shenzhen Hospital, NO1120, LianHua Road, FuTian District, Shenzhen, Guangdong Province, China. Tel.: +86 0755 8392333; fax: +86 0755 8392336.
    Affiliations
    Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
    Search for articles by this author
  • Juwei Mu
    Correspondence
    Corresponding author. National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, NO113, BaoHe Road, LongGang District, Shenzhen, 518116, Guangdong Province, China. Tel.: +86 0755 66619382; fax: +86 0755 66618179.
    Affiliations
    National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.
Published:March 07, 2021DOI:https://doi.org/10.1016/j.jss.2020.11.064

      Abstract

      Background

      More than 50% of patients with palmar hyperhidrosis (PAH) also have plantar hyperhidrosis (PLH). We compared the long-term results of T3 sympathectomy with those of combined T3+T4 sympathectomy among patients with concurrent PAH and PLH.

      Materials and methods

      We retrospectively analyzed the records of patients with concurrent PAH and PLH who underwent T3 alone or T3+T4 sympathectomy from January 1, 2012, to December 31, 2017. Preoperative and postoperative sweating (hyperhidrosis index) was evaluated through questionnaires, physical examination, and outpatient follow-up. The relief rates and hyperhidrosis index were used as outcome measures to compare the efficacy of the two approaches. Patients’ satisfaction and side effects were also evaluated.

      Results

      Of the 220 eligible patients, 60 underwent T3 sympathectomy (T3 group), and 160 underwent T3+T4 sympathectomy (T3+T4 group). Compared with the T3 group, the T3+T4 group showed higher symptom relief rates both for PAH (98.75% versus 93.33%, P = 0.048) and PLH (65.63% versus 46.67%, P = 0.01), and a greater postoperative decrease in both hyperhidrosis indices. The rate of severe compensatory hyperhidrosis also increased (10% versus 5%, P = 0.197), although the rates of overall satisfaction were comparable between the groups. The incidence of postoperative pneumothorax requiring chest tube placement and postoperative neuralgia was also similar. There were no cases of perioperative death, secondary operation, wound infection, or Horner syndrome in either group.

      Conclusions

      Compared with T3 alone, T3+T4 sympathectomy achieved a higher symptom relief rate and a lower hyperhidrosis index. T3+T4 sympathectomy may be a choice for the treatment of concurrent PAH and PLH; however, patients need to be informed that this kind of surgery may increase the risk of compensatory sweating.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Surgical Research
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ureña A.
        • Ramos R.
        • Masuet C.
        • et al.
        An assessment of plantar hyperhidrosis after endoscopic thoracic sympathicolysis.
        Eur J Cardiothorac Surg. 2009; 36: 360-363
        • Tu Y.R.
        • Li X.
        • Lin M.
        • et al.
        Epidemiological survey of primary palmar hyperhidrosis in adolescent in Fuzhou of People's Republic of China.
        Eur J Cardiothorac Surg. 2007; 31: 737-739
        • Sternbach J.M.
        • DeCamp M.M.
        Targeting the sympathetic chain for primary hyperhidrosis: an evidence-based review.
        Thorac Surg Clin. 2016; 26: 407-420
        • Duarte J.B.
        • Kux P.
        Efficacy of endoscopic thoracic sympathicotomy along with severing the Kuntz nerve in the treatment of chronic non-infectious rhinitis.
        Ann Chir Gynaecol. 2001; 90: 189-192
        • Wang Y.C.
        • Sun M.H.
        • Lin C.W.
        • Chen Y.J.
        Anatomical location of T2-3 sympathetic trunk and Kuntz nerve determined by transthoracic endoscopy.
        J Neurosurg. 2002; 96: 68-72
        • Street E.
        • Ashrafi M.
        • Greaves N.
        • Gouldsborough I.
        • Baguneid M.
        Anatomic variation of rami communicantes in the upper thoracic sympathetic chain: a human cadaveric study.
        Ann Vasc Surg. 2016; 34: 243-249
        • Rathinam S.
        • Nanjaiah P.
        • Sivalingam S.
        • Rajesh P.B.
        Excision of sympathetic ganglia and the rami communicantes with histological confirmation offers better early and late outcomes in video assisted thoracoscopic sympathectomy.
        J Cardiothorac Surg. 2008; 3: 50
        • Ramos R.
        • Moya J.
        • Turón V.
        • et al.
        [Primary hyperhidrosis and anxiety: a prospective preoperative survey of 158 patients].
        Arch Bronconeumol. 2005; 41 ([Article in Spanish]): 88-92
        • Wolosker N.
        • Yazbek G.
        • Milanez de Campos J.R.
        • Kauffman P.
        • Ishy A.
        • Puech-Leão P.
        Evaluation of plantar hyperhidrosis in patients undergoing video-assisted thoracoscopic sympathectomy.
        Clin Auton Res. 2007; 17: 172-176
        • Rieger R.
        • Pedevilla S.
        Retroperitoneoscopic lumbar sympathectomy for the treatment of plantar hyperhidrosis: technique and preliminary findings.
        Surg Endosc. 2007; 21: 129-135
        • Hsu C.P.
        • Chen C.Y.
        • Lin C.T.
        • Wang J.H.
        • Chen C.L.
        • Wang P.Y.
        Video-assisted thoracoscopic T2 sympathectomy for hyperhidrosis palmaris.
        J Am Coll Surg. 1994; 179: 59-64
        • Neumayer C.
        • Panhofer P.
        • Zacherl J.
        • Bischof G.
        Effect of endoscopic thoracic sympathetic block on plantar hyperhidrosis.
        Arch Surg. 2005; 140: 676-680
        • de Campos J.R.
        • Kauffman P.
        • Werebe Ede C.
        • et al.
        Quality of life, before and after thoracic sympathectomy: report on 378 operated patients.
        Ann Thorac Surg. 2003; 76: 886-891
        • Scognamillo F.
        • Serventi F.
        • Attene F.
        • et al.
        T2-T4 sympathectomy versus T3-T4 sympathicotomy for palmar and axillary hyperhidrosis.
        Clin Auton Res. 2011; 21: 97-102
        • Reisfeld R.
        Sympathectomy for hyperhidrosis: should we place the clamps at T2-T3 or T3-T4?.
        Clin Auton Res. 2006; 16: 384-389
        • Cerfolio R.J.
        • De Campos J.R.
        • Bryant A.S.
        • et al.
        The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis.
        Ann Thorac Surg. 2011; 91: 1642-1648
        • Keller S.M.
        • Bello R.
        • Vibert B.
        • Swergold G.
        • Burk R.
        Diagnosis of palmar hyperhidrosis via questionnaire without physical examination.
        Clin Auton Res. 2009; 19: 175-181
        • Baumgartner F.J.
        • Reyes M.
        • Sarkisyan G.G.
        • Iglesias A.
        • Reyes E.
        Thoracoscopic sympathicotomy for disabling palmar hyperhidrosis: a prospective randomized comparison between two levels.
        Ann Thorac Surg. 2011; 92: 2015-2019
        • Lin M.
        • Tu Y.
        • Chen J.
        • Li X.
        • Lai F.
        • Lin J.
        [Efficacy comparison of two methods of r3 sympathicotomy for palmar hyperhidrosis].
        Zhonghua Yi Xue Za Zhi. 2014; 94 ([Article in Chinese]): 3745-3747
        • Liu Y.
        • Yang J.
        • Liu J.
        • et al.
        Surgical treatment of primary palmar hyperhidrosis: a prospective randomized study comparing T3 and T4 sympathicotomy.
        Eur J Cardiothorac Surg. 2009; 35: 398-402
        • Chiou T.S.
        • Liao K.K.
        Orientation landmarks of endoscopic transaxillary T-2 sympathectomy for palmar hyperhidrosis.
        J Neurosurg. 1996; 85: 310-315
        • Drott C.
        • Gothberg G.
        • Claes G.
        Endoscopic transthoracic sympathectomy: an efficient and safe method for the treatment of hyperhidrosis.
        J Am Acad Dermatol. 1995; 33: 78-81
        • Bandyk D.F.
        • Johnson B.L.
        • Kirkpatrick A.F.
        • Novotney M.L.
        • Back M.R.
        • Schmacht D.C.
        Surgical sympathectomy for reflex sympathetic dystrophy syndromes.
        J Vasc Surg. 2002; 35: 269-277
        • Moran K.T.
        • Brady M.P.
        Surgical management of primary hyperhidrosis.
        Br J Surg. 1991; 78: 279-283
        • Zhang B.
        • Li Z.
        • Yang X.
        • et al.
        Anatomical variations of the upper thoracic sympathetic chain.
        Clin Anat. 2009; 22: 595-600
        • Cho H.M.
        • Lee D.Y.
        • Sung S.W.
        Anatomical variations of rami communicantes in the upper thoracic sympathetic trunk.
        Eur J Cardiothorac Surg. 2005; 27: 320-324
        • Hederman W.P.
        Present and future trends in thoracoscopic sympathectomy.
        Eur J Surg Suppl. 1994; 572: 17-19
        • Elalfy K.
        • Emile S.
        • Elfeki H.
        • Elmetwally A.
        • Farag M.
        • Gado W.
        Sequential extended thoracoscopic sympathicotomy for palmo-axillo-plantar hyperhidrosis.
        Ann Thorac Surg. 2017; 104: 1200-1207
        • Lin T.S.
        • Fang H.Y.
        Transthoracic endoscopic sympathectomy in the treatment of palmar hyperhidrosis--with emphasis on perioperative management (1,360 case analyses).
        Surg Neurol. 1999; 52: 453-457
        • Drott C.
        • Claes G.
        Hyperhidrosis treated by thoracoscopic sympathicotomy.
        Cardiovasc Surg. 1996; 4: 788-790
        • Kocher G.J.
        • Taha A.
        • Ahler M.
        • Schmid R.A.
        Is clipping the preferable technique to perform sympathicotomy? A retrospective study and review of the literature.
        Langenbecks Arch Surg. 2015; 400: 107-112
        • Li X.
        • Tu Y.R.
        • Lin M.
        • Lai F.C.
        • Chen J.F.
        • Dai Z.J.
        Endoscopic thoracic sympathectomy for palmar hyperhidrosis: a randomized control trial comparing T3 and T2-4 ablation.
        Ann Thorac Surg. 2008; 85: 1747-1751
        • Lai Y.T.
        • Yang L.H.
        • Chio C.C.
        • et al.
        Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy.
        Neurosurgery. 1997; 41: 110-113