Bilateral R5-R8 sympathectomy for compensatory hyperhidrosis: complications and patient satisfaction. / Simpatectomia bilateral R5-R8 no tratamento de hiperidrose compensatória: análise de complicações e satisfação dos pacientes.

OBJECTIVE: The purpose of this study was to assess the quality of life of patients who had undergone bilateral thoracic sympathectomy from R5 to R8 as a treatment for severe and debilitating compensatory hyperhidrosis (CH). METHODS: Twelve patients with severe and debilitating compensatory hyperhidrosis underwent extended sympathectomy (R5-R8) from September 2016 to May 2019 at the Hospital das Clínicas, Federal University of Pernambuco, Brazil. Outcomes such as the level of patient satisfaction with the operation, quality of life scores as well as postoperative complications were assessed. RESULTS: There has been a substantial improvement in the quality of life score of 66% of the sample. In all four domains, a statistical significant difference was seen, regarding the relief of compensatory hyperhidrosis symptoms. CONCLUSIONS: Extended sympathectomy from R5 to R8 was shown to be quite effective in most cases, leading us to believe that this approach could be a therapeutic option for severe compensatory hyperhidrosis.

OBJETIVO: Avaliar a qualidade de vida de pacientes submetidos a simpatectomia torácica bilateral de R5 a R8 como forma de tratamento da hiperidrose compensatória (HC) grave e debilitante em pacientes que foram previamente submetidos a simpatectomia torácica bilateral para tratamento da hiperidrose localizada. MÉTODOS: Doze pacientes com hiperidrose compensatória grave e debilitante foram submetidos a simpatectomia estendida no Hospital das Clínicas da Universidade Federal de Pernambuco, Brasil, entre setembro de 2016 e maio de 2019. Os seguintes desfechos foram estudados: nível de satisfação com a operação, escore de qualidade de vida e as possíveis complicações cirúrgicas. RESULTADOS: Houve significativa melhora na qualidade de vida em 66% da amostra. Em todas as esferas de função, foi evidenciada relevância estatística no que se refere ao alívio dos sintomas relacionados à hiperidrose compensatória. CONCLUSÕES: A simpatectomia estendida de R5 a R8 mostrou-se efetiva na maioria dos casos operados, caracterizando este procedimento como promissor, podendo, após estudos futuros, ser incluído como uma opção terapêutica para a hiperidrose compensatória.

Is there any relationship between quality of life and the level of sympathectomy in primary palmar hyperhidrosis? Single-center experience.

BACKGROUND: The discussions at the surgical levels (sympathectomy levels) about endoscopic thoracic sympathectomy (ETS) method, which is applied in hyperhidrosis treatment in the present day and acknowledged as the golden treatment method, continue. Mainly, most of the studies evaluates postoperative early period results. Our aim in this study is to compare the long-term quality of life depending on the different surgical levels (sympathectomy levels) and evaluate the postoperative complications. METHODS: 165 patients operated due to palmar hyperhidrosis between January 2012 and July 2017 were evaluated. Sympathectomy was performed either by clipping or cauterization and sympathetic nerves included were T2-4, T3-4, or T3 levels. Data were retrospectively reviewed for complications, factors affecting the postoperative quality of life. RESULTS: Ninety of the patients were male (54.5%) and 75 (45.5%) were female. The level of ganglion block was T2-T4 in 62 patients (37.6%), T3-T4 in 46 patients (27.9%), and T3 in 57 patients (34.5%). Early complications were observed in 27 patients (16.4%). Compensatory hyperhidrosis (CH) was observed in 62 patients (37.6%). There was a significant difference in the postoperative quality of life according to ETS level (p < 0.001). Patients who underwent T2-T4 sympathectomy had a lower quality of life than patients who underwent isolated T3 or T3-T4 sympathectomy. CONCLUSION: Based on our results, we recommend performing lower level resections to increase the long-term quality of life in palmar hyperhidrosis patients. The lower risk of CH and comparable quality of life suggest that T3 sympathectomy is more effective.

Unaltered neurocardiovascular reactions to mental stress after renal sympathetic denervation.

Background: The impact of renal denervation (RDN) on muscle sympathetic nerve activity (MSNA) at rest remains controversial. Mental stress (MS) induces transient changes in sympathetic nerve activity, heart rate (HR) and blood pressure (BP). It is not known whether RDN modifies these changes.Purpose: The main objective was to assess the effect of RDN on MSNA and BP alterations during MS.Methods: In 14 patients (11 included in analysis) with resistant hypertension multi-unit MSNA, BP (Finometer ®) and HR were assessed at rest and during forced arithmetics at baseline and 6 months after RDN.Results: Systolic office BP decreased significantly 6 months after RDN (185 ± 29 vs.175 ± 33 mmHG; p = 0.04). No significant changes in MSNA at rest (68 ± 5 vs 73 ± 5 bursts/100hb; p = 0.43) were noted and no significant stress-induced change in group averaged sympathetic activity was found pre- (101 ± 24%; p = 0.9) or post-intervention (108 ± 26%; p = 0.37). Stress was associated with significant increases in mean arterial BP (p < 0.01) and HR (p < 0.01) at baseline, reactions which remained unaltered after intervention. We did not note any correlation between sympathetic nerve activity and BP changes after RDN.Conclusion: Thus, in our group of resistant hypertensives we find no support for the hypothesis that the BP-lowering effect of RDN depends on altered neurovascular responses to stress.

Simpatectomia bilateral R5-R8 no tratamento de hiperidrose compensatória: análise de complicações e satisfação dos pacientes / Bilateral R5-R8 sympathectomy for compensatory hyperhidrosis: complications and patient satisfaction

RESUMO Objetivo: Avaliar a qualidade de vida de pacientes submetidos a simpatectomia torácica bilateral de R5 a R8 como forma de tratamento da hiperidrose compensatória (HC) grave e debilitante em pacientes que foram previamente submetidos a simpatectomia torácica bilateral para tratamento da hiperidrose localizada. Métodos: Doze pacientes com hiperidrose compensatória grave e debilitante foram submetidos a simpatectomia estendida no Hospital das Clínicas da Universidade Federal de Pernambuco, Brasil, entre setembro de 2016 e maio de 2019. Os seguintes desfechos foram estudados: nível de satisfação com a operação, escore de qualidade de vida e as possíveis complicações cirúrgicas. Resultados: Houve significativa melhora na qualidade de vida em 66% da amostra. Em todas as esferas de função, foi evidenciada relevância estatística no que se refere ao alívio dos sintomas relacionados à hiperidrose compensatória. Conclusões: A simpatectomia estendida de R5 a R8 mostrou-se efetiva na maioria dos casos operados, caracterizando este procedimento como promissor, podendo, após estudos futuros, ser incluído como uma opção terapêutica para a hiperidrose compensatória.

ABSTRACT Objective: The purpose of this study was to assess the quality of life of patients who had undergone bilateral thoracic sympathectomy from R5 to R8 as a treatment for severe and debilitating compensatory hyperhidrosis (CH). Methods: Twelve patients with severe and debilitating compensatory hyperhidrosis underwent extended sympathectomy (R5-R8) from September 2016 to May 2019 at the Hospital das Clínicas, Federal University of Pernambuco, Brazil. Outcomes such as the level of patient satisfaction with the operation, quality of life scores as well as postoperative complications were assessed. Results: There has been a substantial improvement in the quality of life score of 66% of the sample. In all four domains, a statistical significant difference was seen, regarding the relief of compensatory hyperhidrosis symptoms. Conclusions: Extended sympathectomy from R5 to R8 was shown to be quite effective in most cases, leading us to believe that this approach could be a therapeutic option for severe compensatory hyperhidrosis.

Anxiety after Sympathectomy in patients with primary palmar hyperhidrosis may prolong the duration of compensatory hyperhidrosis.

BACKGROUND: Compensatory hyperhidrosis (CH) is a frequent side effect after sympathectomy for the treatment of primary palmar hyperhidrosis. We determined the effects of demographic and clinical factors which may increase the duration of CH (DCH). METHODS: One hundred twenty-two patients who had undergone sympathectomies from 2014 to 2016 were retrospectively reviewed. Anxiety was evaluated using the State and Trait Anxiety Inventory score. Follow-up evaluations continued until CH remitted. A Cox proportional hazards model was used to determine the association between DCH and variables. RESULTS: DCH ranged from 5 to 27 weeks (median, 11.47 weeks). Severe CH (HR = 0.318, 95% CI, 0.136-0.741) and exacerbated anxiety 1 month post-operatively (HR = 0.816, 95% CI, 0.746-0.893) may prolong CH. A positive correlation between post-operative anxiety and DCH was common in patients with moderate or severe CH, and in cases with forearm CH. CONCLUSIONS: Pre- and post-operative anxiety should be evaluated, and anti-anxiety treatment is offered to patients with moderate-to-severe CH to shorten the DCH.

Calidad de vida en pacientes con hiperhidrosis primaria sometidos a simpatectomía videotoracoscópica / Quality of life after videothoracic simpathectomy in patients with primary hyperhidrosis

Introduction: Primary hyperhidrosis is characterized by excessive sweating that exceeds the physiological needs to maintain thermal homeostasis of the body. This study aims to assess the change in quality of life of patients operated on videothoracoscopic sympathectomy. Materials and Methods: We included all patients operated with this technique in the period between 2004 and 2010, in FACh Hospital. A standardized cuestionary was used to measure severity of hyperhidrosis and quality of life during pre and postoperative. Results: 61 patients, 57 percent female and mean age of 25 years. Preoperative sweating was barely tolerable or unacceptable in 81 percent, and preoperative quality of life was poor or very poor in 82 percent of patients. After surgery sweating was never noticed or tolerable at 85 percent and the quality of life was better in 84 percent of patients. 78 percent of patients developed compensatory sweating; however the 87 percent were satisfied with the outcome of surgery. Conclusion: Videothoracoscopic sympathectomy offers excellent results that are measurable in terms of improvement of quality of life, but often associated with the phenomenon of compensatory sweating. Despite the development of this sequel, the majorities of operated patients are satisfied with the surgical results and improve their quality of life.

Introducción: La hiperhidrosis primaria se caracteriza por sudoración excesiva que supera las necesidades fisiológicas para mantener la homeostasis térmica del cuerpo. El objetivo de este trabajo es evaluar el cambio en la calidad de vida de los pacientes operados de simpatectomía videotoracoscópica. Material y Método: Estudio de tipo transversal del total de pacientes operados con esta técnica en el Hospital Fuerza Aérea de Chile (FACh) en el período entre 2004 y 2010. Se utilizó una encuesta estandarizada y validada en la literatura para medir severidad de la hiperhidrosis y calidad de vida en período pre y postoperatorio. Resultados: 61 pacientes, 57 por ciento de género femenino y promedio de edad 25 años. La sudoración preoperatoria era apenas tolerable o intolerable en 81 por ciento y la calidad de vida preoperatoria era pobre o muy pobre en 82 por ciento de los pacientes. Posterior a la cirugía la sudoración nunca se notaba o era tolerable en 85 por ciento y la calidad de vida era mejor en 84 por ciento de los pacientes. El 78 por ciento de los pacientes operados desarrolló sudoración compensatoria, sin embargo, el 87 por ciento de los pacientes estaban satisfechos con el resultado de la cirugía. Conclusión: La simpatectomía videotoracoscópica ofrece excelentes resultados que son medibles en términos de mejoría de la calidad de vida, pero asociado frecuentemente al fenómeno de sudoración compensatoria. Pese al desarrollo de esta secuela, la mayoría de los pacientes operados están satisfechos con los resultados quirúrgicos y mejoran su calidad de vida.

Thoracic sympathectomy at the level of the fourth and fifth ribs for the treatment of axillary hyperhidrosis.

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%) and 81 (68.6%) showed complete resolution of the symptoms in the early and late postoperative periods, respectively. Compensatory hyperhidrosis occurred in 49 patients (41.5%) in the early postoperative period and in 77 (65.2%) in the late postoperative period. Of those 77, 55 (71.4%) categorized the compensatory hyperhidrosis as mild. In the early postoperative period, 110 patients (93.2%) were satisfied with the surgical results, and 104 (88.1%) 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.

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.

Is gender a predictive factor for satisfaction among patients undergoing sympathectomy to treat palmar hyperhidrosis?

UNLABELLED: Video-assisted thoracic sympathectomy (VATS) is currently the procedure of choice for the definitive treatment of primary hyperhidrosis because it is an effective, safe, and minimally invasive method. The aim of VATS treatment is to improve the quality of life through the reduction of excessive sudoresis. The purpose of this study was to assess the quality of life after VATS for treating palmar hyperhidrosis according to gender. METHODS: A total of 1044 patients who submitted to the surgical treatment for palmar hyperhidrosis from June 2000 to February 2008 were retrospectively evaluated. The patients were divided into two groups according to gender [719 (68.8%) females and 325 (31.2%) males]. RESULTS: There are no statistically significant differences between genders with regard to the quality of life in palmar hyperhidrosis patients (p = 0.726). In the interview that was performed 30 days after surgery, the quality of life in the two groups had improved, with no statistical difference between the groups. CONCLUSION: Patients with palmar hyperhidrosis present with an improvement in the quality of life after VATS regardless of gender.

Is gender a predictive factor for satisfaction among patients undergoing sympathectomy to treat palmar hyperhidrosis?

Video-assisted thoracic sympathectomy (VATS) is currently the procedure of choise for the definitive treatment of primary hyperhidrosis because it is an effective, safe, and minimally invasive method. The aim of VATS treatment is to improve the quality of life through the reduction of excessive sudoresis. The purpose of this study was to assess the quality of life after VATS for treating palmar hyperhidrosis according to gender. METHODS: A total of 1044 patients who submitted to the surgical treatment for palmar hyperhidrosis from June 2000 to February 2008 were retrospectively evaluated. The patients were divided into two groups according to gender [719 (68.8 percent) females and 325 (31.2 percent) males]. RESULTS: There are no statistically significant differences between genders with regard to the quality of life in palmar hyperhidrosis patients (p = 0.726). In the interview that was performed 30 days after surgery, the quality of life in the two groups had improved, with no statistical difference between the groups. CONCLUSION: Patients with palmar hyperhidrosis present with an improvement in the quality of life after VATS regardless of gender.

Thoracoscopic sympathectomy for palmar and axillary hyperhidrosis: four-year outcome and quality of life after bilateral 5-mm dual port approach.

BACKGROUND: During recent years, thoracoscopic sympathectomy has been the standard treatment for hyperhidrosis. Different surgical techniques have been described without proving their advantages compared with other procedures. This study was designed to evaluate our modification of thoracoscopic sympathectomy and to compare the effectiveness between axillary and palmar hyperhidrosis. METHODS: Ninety patients with axillary or palmar hyperhidrosis who underwent bilateral thoracoscopic sympathectomy with single-lumen ventilation with a dual 5-mm port approach were followed up for a median of 3.9 (range, 1-6) years. The clinical course and data during the hospitalization and consultation in our outpatient clinic were reviewed. The following parameters were evaluated: clinical improvement, satisfaction, changes in quality of life, and compensatory sweating and gustatory sweating. RESULTS: The perioperative mortality was 0, and the morbidity was 6.5%. In 81% clinical improvement of sweating was noticed; 55% did not sweat at all. A total of 88% of patients were satisfied with the result of the operation. The rates of compensatory sweating and gustatory sweating were 93.5% and 49.4%, respectively. The result of sympathectomy in patients with palmar hyperhidrosis were significantly better concerning rate of satisfaction (p = 0.006) and improvement of symptoms (p = 0.027) compared with patients with axillary symptoms. Additionally it was found that the compensatory sweating had significantly impacted the satisfaction rating of the operation. CONCLUSION: Currently different effective surgical approaches for the treatment of hyperhidrosis with improvement rates of more than 80% are available. The quality of the intervention has to be evaluated by changes in quality of life and intensity of compensatory sweating. Thoracoscopic sympathectomy as performed in our institution offers results and complications comparable to previously published trials; however, because of single-lumen ventilation the management is much easier. Therefore, this technique offers an interesting option for the treatment of patients with palmar and axillary hyperhidrosis.

Factors affecting outcome following endoscopic thoracic sympathectomy.

BACKGROUND: Endoscopic thoracic sympathectomy (ETS) is an effective treatment for palmar hyperhidrosis and has been extended to craniofacial symptoms such as blushing and facial sweating. Adverse effects, including compensatory sweating, may cause patients to regret surgery. Such adverse events are currently unpredictable. This study investigated whether age, sex or bodyweight influenced the outcome. METHODS: A total of 110 patients who had bilateral ETS for palmar hyperhidrosis or facial symptoms (blushing or sweating) were asked to complete a questionnaire before and after surgery regarding physical and emotional symptoms, and overall satisfaction. RESULTS: Seventy-nine usable questionnaires were obtained. A decrease (an improvement) in physical symptom score was found in all patients; the median (interquartile range) change was - 15 (-9 to - 18) for facial symptoms and - 8 (-6.75 to - 9) for palmar symptoms. Similarly, there was an improvement in emotional symptom score of - 16 (-8 to - 28) for facial symptoms and - 13 (-7.25 to - 18.5) for palmar symptoms. More compensatory sweating was noted in those treated for facial symptoms (P = 0.007). There was no influence of age, sex or body mass index on outcome. CONCLUSION: ETS is an effective treatment for palmar and facial symptoms. Side-effects may be worse in patients treated for facial symptoms.

Severity of compensatory sweating after thoracoscopic sympathectomy.

BACKGROUND: Compensatory sweating is a well-known side effect after sympathectomy for hyperhidrosis. It is often claimed to correlate with the extent of sympathectomy, but results from the literature are conflicting, and few have actually considered differences in the intensity of compensatory sweating. METHODS: A total of 158 patients underwent thoracoscopic sympathectomy for primary hyperhidrosis or blushing, or both. Sympathectomy was performed bilaterally at Th2 for facial hyperhidrosis/blushing (n = 49), Th2-3 for palmar hyperhidrosis (n = 62), and Th2-4 for axillary hyperhidrosis (n = 47). RESULTS: Follow-up by questionnaire was possible in 94% of patients after a median of 26 months. Compensatory sweating occurred in 89% of patients and was so severe in 35% that they often had to change their clothes during the day. The frequency of compensatory sweating was not significantly different among the three groups, but severity was significantly higher after Th2-4 sympathectomy for axillary hyperhidrosis (p = 0.04). Gustatory sweating occurred in 38% of patients, and 16% of patients regretted the operation. CONCLUSIONS: Compensatory and gustatory sweating were remarkably frequent side effects after thoracoscopic sympathectomy for primary hyperhidrosis. We found no significant difference between the level of sympathectomy and the occurrence of compensatory sweating. However, it appears that this is the first study to demonstrate that severe sweating is significantly more frequent after Th2-4 sympathectomy for axillary hyperhidrosis. We encourage informing patients thoroughly about these side effects before surgery.

Posterior approach for the simultaneous, bilateral thoracoscopic sympathectomy.

If there is an indication for sympathectomy in the case of severe hyperhidrosis or rubeosis, in our opinion the posterior approach is preferable because of the advantages in surgical technique and anesthesia. Bilateral treatment can be accomplished in a single admission, with all the concomitant advantages.