Sustained benefit lasting one year from T4 instead of T3-T4 sympathectomy for isolated axillary hyperhidrosis

Marco Antonio S Munia, Nelson Wolosker, Paulo Kaufmann, José Ribas Milanes de Campos, Pedro Puech-Leão, Marco Antonio S Munia, Nelson Wolosker, Paulo Kaufmann, José Ribas Milanes de Campos, Pedro Puech-Leão

Abstract

Introduction: Level T4 video-assisted thoracoscopic sympathectomy proved superior to T3-T4 treatment for controlling axillary hyperhidrosis at the initial and six-month follow-ups of these patients.

Objective: To compare the results of two levels of sympathectomy (T3-T4 vs. T4) for treating axillary sudoresis over one year of follow-up.

Methods: Sixty-four patients with axillary hyperhidrosis were randomized to denervation of T3-T4 or T4 alone and followed prospectively. All patients were examined preoperatively and were followed postoperatively for one year. Axillary hyperhidrosis treatment was evaluated, along with the presence, location, and severity of compensatory hyperhidrosis and self-reported quality of life.

Results: According to patient reports after one year, all cases of axillary hyperhidrosis were successfully treated by surgery. There were no instances of treatment failure. After six months, compensatory hyperhidrosis was present in 27 patients of the T3-T4 group (87.1%) and in 16 patients of the T4 group (48.5%). After one year, all T3-T4 patients experienced some degree of compensatory hyperhidrosis, compared to only 14 patients in the T4 group (42.4%). In addition, compensatory hyperhidrosis was less severe in the T4 patients (p < 0.01). Quality of life was poor before surgery, and it improved in both groups at six months and one year of follow-up (p = 0.002). There were no cases of mortality, no significant postoperative complications, and no need for conversion to thoracotomy in either group.

Conclusion: Both techniques were effective for treating axillary hyperhidrosis, but the T4 group showed milder compensatory hyperhidrosis and greater patient satisfaction at the one-year follow-up.

References

    1. Glaser DA. The use of botulinum toxins to treat hyperhidrosis and gustatory sweating syndrome. Neurotox Res. 2006;9:173–7.
    1. Atkins JL, Butler PE. Hyperhidrosis: A Review of Current Management. Plast Recon Surg. 2002;110:222–8.
    1. Rompel R, Scholz S. Subcutaneous Curettage vs. Injection of Botulinum Toxin A for Treatment of Axillary Hyperhidrosis. J Eur Acad Dermatol Venereol. 2001;15:207–11.
    1. Proebstle TM, Schneiders V, Knop J. Gravimetrically Controlled Efficacy of Subcorial Curettage: A Prospective study for Treatment of Axillary Hyperhidrosis. Dermatol Surg. 2002;28:1022–6.
    1. Loureiro MP, Campos JR, Kauffman P, Jatene FB, Weigmann S, Fontana A. Endoscopic lumbar sympathectomy for women: effect on compensatory sweat. Clinics. 2008;63:189–96.
    1. Munia MA, Wolosker N, Kauffman P, de Campos JR, Puech-Leão P. A randomized trial of T3-T4 versus T4 sympathectomy for isolated axillary hyperhidrosis. J Vasc Surg. 2007;45:130–3.
    1. de Campos JR, Wolosker N, Takeda FR, Kauffman P, Kuzniec S, et al. The body mass index and level of resection: predictive factors for compensatory sweating after sympathectomy. Clin Auton Res. 2005;15:116–20.
    1. de Campos JR, Kauffman P, Werebe Ede C, Andrade Filho LO, Kusniek S, Wolosker N, et al. Quality of life, before and after thoracic sympathectomy: report on 378 operated patients. Ann Thorac Surg. 2003;76:886–91.
    1. Wolosker N, Yazbek G, Milanez de Campos JR, Kauffman P, Ishy A, Puech-Leão P. Evaluation of plantar hyperhidrosis in patients undergoing video-assisted thoracoscopic sympathectomy. Clin Auton Res. 2007;17:172–6. Epub 2007 Jun 12.
    1. Lawrence CM, Lonsdale Eccles AA. Selective sweat gland removal with minimal skin excision in the treatment of axillary hyperhidrosis: a retrospective clinical and histological review of 15 patients. Br J Dermatol. 2006;155:115–8.
    1. Hsu CP, Shia SE, Hsia JY, Chuang CY, Chen CY. Experiences in Thoracoscopic Simpathectomy for Axillary Hyperhidrosis and Osmidrosis : focusing on the extent of sympathectomy. Arch Surg. 2001;136:1115–17.
    1. Byrne J, Walsh TN, Hederman WP. Endoscopic Transthoracic Electrocautery of the Simpathetic Chain for Palmar and Axillary Hyperhydrosis. Br J Med. 1990:771046–9.
    1. Rex LO, Drott C, Claes G, Gothberg G, Dalman P. The Boras Experience of Endoscopic Toracic Sympathicotomy for Palmar, Axillary, Facial Hyperhidrosis and Facial Blushing. Eur J Surg. 1998;580(suppl):23–6.
    1. Hsu CP, Chen CY, Hsia JY, Shai SE. Resympathectomy for Palmar and Axillary Hyperhidrosis. Br J Surg. 1998;85:1504–5.
    1. Gossot D, Debrosse D, Grunenwald D. Endoscopic Thoracic Sympathectomy for Isolated Axillary Hyperhidrosis. Ann Dermatol Venereol. 2000;127:1065–7.
    1. Gossot D, Galetta D, Pascal A, Debrosse D, Caliandro R, Girard P, Stern JB, Grunenwald D. Long-term Results of Endoscopic Thoracic Sympathectomy for Upper Limb Hyperhidrosis. Ann Thorac Surg. 2003;75:1075–9.
    1. Claes G. Indications for Endoscopic Thoracic Sympathectomy. Clin Auton Res. 2003;13(suppl1):l/16–l/19.
    1. Yazbek G, Wolosker N, de Campos JR, Kauffman P, Ishy A, Puech-Leao P. Palmar hyperhidrosis--which is the best level of denervation using video-assisted thoracoscopic sympathectomy: T2 or T3 ganglion? J Vasc Surg. 2005;42:281–5.
    1. Masters A, Rennie JA. Endoscopic Transthoracic Simpathectomy for Idiopathic Upper Limb Hyperhidrosis. Clin Auton Res. 1992;2:349–52.
    1. Lin CC, Wu HH. Endoscopic T4 Sympathetic Block By Clamping ESB4 in Treatment of Hyperhidrosis Palmaris et Axillaris -– Experience of 165 Cases. Ann Chir Gynecol. 2001;90:167–9.
    1. Licht PB, Pilegaard HK. Severity of Compensatory Sweating after Thoracoscopic Sympathectomy. Ann Thorac Surg. 2004;78:427–31.
    1. Licht PB, Jorgensen OD, Ladegaard L, Pilegaard HK. Thoracoscopic sympathectomy for axillary hyperhidrosis: the influence of T4. Ann Thorac Surg. 2005;80:455–9.
    1. Cameron AE. Specific Complications and Mortality of Endoscopic Thoracic Sympathectomy. Clin Auton Res. 2003;13:31–5.
    1. Neumayer C, Zacherl J, Holak G, Fugger R, Jakesz R, Herbst F, et al. Limited Endoscopic Thoracic Simpathectomy Block for Hyperhidrosis of the Upper Limb: Reduction of Compensatory Sweating by Clipping T4. Surg Endosc. 2004;18:152–6.
    1. Lin TS. Endoscopic Clipping in Video-assisted Thoracoscopic Sympathectomy Blockade for Axillary Hyperhidrosis. An Analysis of 26 Cases. Surg Endosc. 2001;15:126–8.
    1. Dewey TM, Herbert MA, Hill SL, Prince SL, Mack MJ. One-Year Follow-Up After Thoracoscopic sympathectomy for Hyperhidrosis: Outcomes and Consequences. Ann Thorac Surg. 2006;81:1227–32. discussion 1232–3.
    1. Wolosker N, Yazbek G, Ishy A, de Campos JR, Kauffman P, Puech-Leão P. Is sympathectomy at t4 level better than at t3 level for treating palmar hyperhidrosis? J Laparoendosc Adv Surg Tech A. 2008;18:102–6.
    1. Milanez de Campos JR, Kauffman P, Wolosker N, Munia MA, de Campos Werebe E, Andrade Filho LO, et al. Axillary hyperhidrosis: T3/T4 versus T4 thoracic sympathectomy in a series of 276 cases. J Laparoendosc Adv Surg Tech A. 2006;16:598–603.

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