Clinical Results According to the Level and Extent of Sympathicotomy in Essential Hyperhidrosis

Choi, Soon Ho; Park, Kwon Jae; Lee, Sam Yoon

Abstract

BACKGROUND: Video-assisted thoracic sympathicotomy is a safe and effective therapy for the treatment of essential hyperhidrosis with immediate symptomatic improvement. However, this is offset by the occurrence of a high rate of side effects, such as embarrassing compensatory hyperhidrosis. Therefore, by comparing and assessing the degree of symptomatic improvement or compensatory sweating following sympathicotomy at various levels and the extent of block, we are to determine the optimal level of sympathicotomy and which method will result in minimal side effects and maximal benefits. MATERIAL AND METHOD: From January 1998 to June 2001, the thoracoscopic sympathicotomy was performed in 150 patients suffering from essential hyperhidrosis in the Dept. of Thoracic and Cardiovascular Surgery, Wonkwang University Hospital. The patients were divided into three groups. Group I(n=50): patients having undergone T2,3,4 sympathicotomy, Group II(n=50): patients having undergone T2 sympathicotomy which consist of blocking the interganglionic neural fiber on the second rib, and group III(n=50): patients having undergone T3 sympathicotomy which consist of blocking the interganglionic neural fiber on the third rib. The parameters were composed of the satisfaction rate of treatment, the degree of compensatory sweating, postoperative complications, and changes of plantar sweating.
RESULTS
There was no difference in age and sex among the groups. All of the treated patients obtained satisfactory alleviation of essential hyperhidrosis in immediate postoperative period. However the rate of long-term satisfaction were 80%, 92%, and 96% in groups I, II, and III respectively(p<0.05). More than embarrassing compensatory hyperhidrosis was present in 50%, 28%, and 18% in groups I, II, and III respectively(p<0.05). Slight but comfortable amounts of palmar humidness was expressed in decreasing order, group III(34%), group II(6%), and group I(4%) respectively (p<0.05). In regard to plantar sweating, decrease in sweating was expressed in each of the three groups, but was not significant between the groups.
CONCLUSION
we suggested that the incidence and degree of compensatory hyperhidrosis is closely related to the site and the extent of thoracic sympathicotomy. The resection of the lower interganglionic neural fiber of the second thoracic sympathetic ganglion on the third rib is a practical and minimally invasive method for the treatment of essential hyperhidrosis than other surgical methods. It showed less incidence and degree of compensatory truncal hyperhidrosis and facial anhidrosis, and also caused lesser dryness of hand.