Simpatectomia torácica ao nível de 4ª e 5ª costelas para o tratamento de hiper-hidrose axilar / Thoracic sympathectomy at the level of the fourth and fifth ribs for the treatment of axillary hyperhidrosis

OBJETIVO: Descrever os resultados clínicos e o grau de satisfação de pacientes submetidos à simpatectomia torácica ao nível de 4ª e 5ª costelas (R4-R5) para o tratamento da hiper-hidrose axilar. MÉTODOS: Foram incluídos 118 pacientes com diagnóstico de hiper-hidrose axilar e submetidos à simpatectomia torácica ao nível de R4-R5, realizada por um único cirurgião, no Hospital de Clínicas da Universidade Federal do Paraná, Curitiba (PR), entre março de 2003 e dezembro de 2007. Dados relativos à resolução da sudorese axilar, ao grau de satisfação com o resultado da cirurgia e ao efeito compensatório no pós-operatório precoce (7 dias) e tardio (1 ano) foram coletados. RESULTADOS: Dos 118 pacientes do estudo, 99 (83,9 por cento) e 81 (68,6 por cento) apresentaram resolução total dos sintomas no pós-operatório precoce e tardio, respectivamente. Houve efeito compensatório em 49 pacientes (41,5 por cento) no pós-operatório precoce e em 77 (65,2 por cento) no pós-operatório tardio. Desses 77, 55 (71,4 por cento) consideraram esses efeitos como leves. No pós-operatório precoce, 110 pacientes (93,2 por cento) estavam satisfeitos com os resultados da cirurgia, enquanto 104 pacientes (88,1 por cento) mantinham-se satisfeitos no pós-operatório tardio. CONCLUSÕES: A simpatectomia ao nível R4-R5 é eficaz na resolução da hiper-hidrose axilar primária. O grau de satisfação dos pacientes com os resultados em longo prazo é alto. O efeito compensatório leve é o principal efeito colateral relacionada a essa técnica.

OBJECTIVE: To describe the clinical results and the degree of satisfaction of patients submitted to thoracic sympathectomy at the level of the fourth and fifth ribs (R4-R5) for the treatment of axillary hyperhidrosis. METHODS: We included 118 patients diagnosed with axillary hyperhidrosis and having undergone axillary sympathectomy at the R4-R5 level between March of 2003 and December of 2007 at the Paraná Federal University Hospital de Clínicas, located in the city of Curitiba, Brazil. All procedures were carried out by the same surgeon. Data regarding the resolution of axillary hyperhidrosis and the degree of patient satisfaction with the surgical outcome, as well as compensatory hyperhidrosis in the early and late postoperative periods (after 7 days and after 12 months, respectively), were collected. RESULTS: Of the 118 patients evaluated, 99 (83.9 percent) and 81 (68.6 percent) showed complete resolution of the symptoms in the early and late postoperative periods, respectively. Compensatory hyperhidrosis occurred in 49 patients (41.5 percent) in the early postoperative period and in 77 (65.2 percent) in the late postoperative period. Of those 77, 55 (71.4 percent) categorized the compensatory hyperhidrosis as mild. In the early postoperative period, 110 patients (93.2 percent) were satisfied with the surgical results, and 104 (88.1 percent) remained so in the late postoperative period. CONCLUSIONS: Sympathectomy at the R4-R5 level is efficient in the resolution of primary axillary hyperhidrosis. The degree of patient satisfaction with the long-term surgical results is high. Mild compensatory hyperhidrosis is the main side effect associated with this technique.

Expectativas y satisfacción en el tratamiento del neumotórax espontáneo primario recurrente tratado por toracotomía o cirugía torácica video-asistida / Expectations and patient satisfaction related to the use of thoracotomy and video-assisted thoracoscopic surgery for treating recurrence of spontaneous primary pneumothorax

OBJETIVO: Comparar los resultados de la toracotomía con la video-assisted thoracoscopic surgery (VATS, cirugía torácica video-asistida) en el tratamiento de las recurrencias del neumotórax espontáneo primario. MÉTODOS: Se revisaron los expedientes clínicos de los pacientes con neumotórax primario recurrente dividiéndose en dos grupos: pacientes sometidos a toracotomía (n = 53, grupo toracotomía) y pacientes sometidos a VATS (n = 47, grupo VATS). RESULTADOS: La morbilidad fue mayor en el grupo A. Sin mortalidad en ninguno de los dos grupos. La duración de la hospitalización fue similar. Los pacientes del grupo toracotomía necesitaron más dosis de narcóticos durante períodos más largos de tiempo que los del grupo VATS (p < 0.05). Se presentó una recurrencia en el grupo toracotomía (3 por ciento). El 68 por ciento de los pacientes del grupo VATS y el 21 por ciento del grupo toracotomía clasificaron su dolor como insignificante transcurrido un mes de la cirugía (p < 0.05). A los tres años, el 97 por ciento de los sometidos a VATS se consideraron totalmente recuperados comparado con el 79 por ciento del grupo de toracotomía (p < 0.05). El 90 por ciento del grupo toracotomía y el 3 por ciento del grupo VATS se quejaban de dolor necesitando analgésicos por más de una vez al mes, 13 por ciento de los sometidos a toracotomía requirieron la asistencia de la clínica del dolor. CONCLUSIONES: La VATS es la primera elección en el tratamiento de la recidiva del neumotórax espontáneo primario.

OBJECTIVE: To compare the outcomes of thoracotomy and video-assisted thoracoscopic surgery (VATS) in the treatment of recurrence of primary spontaneous pneumothorax. METHODS: Medical records of patients presenting recurrence of primary spontaneous pneumothorax were retrospectively reviewed. Patients were divided into two groups: those who underwent conservative thoracotomy (n = 53, thoracotomy group); and those who underwent VATS (n = 47, VATS group). RESULTS: Although there were no deaths in either group and the length of hospital stays was similar between the two, there was greater morbidity in the thoracotomy group. Patients in the thoracotomy group required more pain medication for longer periods than did those in the VATS group (p < 0.05). In the thoracotomy group, the rate of recurrence was 3 percent. Pain was classified as insignificant at one month after the operation by 68 percent of patients in the VATS group and by only 21 percent of those in the thoracotomy group (p < 0.05). At three years after the surgical procedure, 97 percent of the VATS group patients considered themselves completely recovered from the operation, compared with only 79 percent in the thoracotomy group (p < 0.05). Chronic or intermittent pain, requiring the use of analgesics more than once a month, was experienced by 90 percent of the thoracotomy group patients and 3 percent of the VATS group patients. In addition, 13 percent of the thoracotomy group patients required clinical pain management. CONCLUSIONS: We recommend VATS as the first-line surgical treatment for patients with recurrent primary spontaneous pneumothorax.