I. Tarfusser
Centro di Chirurgia S. Anna, Merano, Italy
13th International Symposium on Sympathetic Surgery (ISSS) 10th+12th October 2015, Pisa, Italy
INTRODUCTION
Essential palmar hyperhidrosis (HH) is regularly associated with plantar HH. It has been reported that endoscopic transthoracic sympathectomy (ETS) may also reduce footsweat in over 50% of the patients. Unfortunately, in most patients this effect is not permanent and plantar HH tends to reappear and return to previous levels within months. Induced by a first patient who demanded a combined procedure, the approach was subsequently offered to a small selection of patients with debilitating palmo-plantar hyperhidrosis (PPHH) who had not responded to conventional treatment.
MATERIAL AND METHODS
Between 2017 and 2019, 14 patients (8 F, 6 M), age range 14 to 53 (mean 33.9 years), unterwent combined bilateral retroperitoneoscopic and thoracoscopic sympathectomy. 2 patients had undergone previous ETS procedures and suffered significant recurrence of palmar HH.
The procedure was carried out in the following sequence:
1. lumbar retroperitoneoscopic block of the sympathetic chain using 3-4 clips applied interganglionically at the level of L3-4, first in the right flank, then on the left side.
2. 2-port thoracoscopic sympathectomy T3 (ganglion oriented cut + ablation), first left, then right. Two patients opted for the clamping method. No chest drain was set.
Follow-up was carried out with a questionnaire 5-29 months postoperatively.
RESULTS
Total operating time ranged from 85-160 minutes, mean 111.4 minutes. As expected, the ELS fraction was more time-consuming (55-95 minutes, mean 74.6 minutes) than the ETS procedure (30-65 minutes, mean 37.2 minutes). 2 patients had local pleural adhesions after previous surgery, requiring time-consuming lysis. No complications were encountered. Need for analgesics in the first postoperative hours was comparable to single procedures. Total hospitalization was 24 hours for all patients.
At follow-up (5-29 months, mean 19) 37.5% declared themselves completely satisfied, 62.5% satisfied with accepable side-effects. No patient expressed dissatisfaction or regretted the procedure. Compensatory sweating (CS) was present in all, ranging from mild to moderate. 2 patients reported occasionally pronounced CS in hot conditions, responding well to oxybutynine.
Average quality of life score improved from 1.1 (preoperatively) to 8.5 (at follow-up) on a 0-10 scale. All would certainly (87.5%) or probably (12.5%) redo the operation if having to decide again.
CONCLUSIONS
Combining ETS (T3) and ELS appears to be a suitable option for patients with severe to extreme PPHH, without adding significantly to postoperative discomfort and side-effects, while saving the patient multiple anesthesias, costs and time off-work.
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