I. Tarfusser, C. Drott, G. Göthberg e G. Claes
G Ital Dermatol Venereol 1993, Vol. 128, N. 10, 527-531
Abstract:
Upper limb hyperhidrosis affects predominantly young patients with a prevalence of 0.6-1 %, causing considerable psycho-social problems in some. This paper summarizes our experience with Endoscopic Transthoracic Sympathectomy, a minimal-invasive surgical method available to patients who fail to respond to conventional local therapy. Technique. With the patient in general anesthesia, an artificial pneumothorax is created and a modified resectoscope is introduced into the pleural cavity through a single port. The ganglia 2-4 of the thoracic sympathetic chain are destroyed by electrocoagulation. Both thoracic cavities are dealt with during the same session. The patient is released from hospital the day after the operation. Results. The procedure was performed in 481 patients with palmar hyperhidrosis (957 thoracical cavities-5 monolateral operations due to unilateral symptoms) with a mean age of 29 years (12-58) and female predominance (63%). Mean hospital stay was 1.3 days (1-8) and full activity was resumed after 7 days (1-40). Postoperative persistence of pneumothorax occurred in 3 cases (0.6%), a hemothorax in 1 (0. 2 %), requiring suction-drainage for 24 hours. 1 patient (0.2%) had a persistent Horner's syndrome. Primary treatment failure occurred in 6 (1.2 %), recurrence of symptoms in 5 (I%); all of these patients were successfully reoperated. In 98% of patients hyperhidrosis disappeared or improved considerably; this figure remained essentially unchanged at medium and long-term follow-up. Conclusion. Endoscopic Transthoracic Sympathectomy is an efficient and safe procedure for patients with moderate to severe palmar hyperhidrosis who failed to respond to non-invasive therapy, offering immediate and persistent cure in most cases.
Keywords: Hyperhidrosis - Surgery – Sympathectomy - Endoscopy.
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