Primary Focal Hyperhidrosis; Treatments of Thoracoscopic Surgery
Bayrakçi Onur *
Department of Thoracic Surgery, Ersin Arslan Training and Research Hospital, Eyüpoğlu Mah, Hürriyet Cad. No: 40, Şahinbey Gaziantep, Turkey.
*Author to whom correspondence should be addressed.
Background: Primary hyperhidrosis is an excessive amount of sweating disorder that bothers the person in the palms, soles, axillae and craniofacial regions. Primary hyperhidrosis is seen in 4.8% of the general population. Topical cream, parasympatholytic drugs, iontophoresis and botulinum toxin are used in the treatment of hyperhidrosis. Thoracic sympathetic surgery is another treatment method for patients who do n't respond to medical treatments. Outcomes of the surgical treatment of hyperhidrosis were aimed in the study.
Methodology: This study was done to include patients with a diagnosis of hyperhidrosis who admitted to hospital between Jan 2015 and Sep 2021. Digital data were analyzed by evaluating patients' age, gender, thyroid function tests, medical treatments, surgical methods, postoperative clinical features, length of hospital stay, complications and disease recurrence. According to the preference of the surgeon, it was done to operate with uniport or two ports in this method (sympathectomy or sympatholysis). However, a three-port or minithoracotomy was done due to insufficient exploration or bleeding. The statistical analysis of the study was done with the Chi-square test.
Results: The incidence of hyperhidrosis was 0.38%. It was mostly seen in the male gender and, in the ages of 18-28 ranges. Localization of sweating was most often palmar (43.3%) in primary hyperhidrosis. Stress was a factor that increased sweating. The most common surgical method was uni-port video-assisted thoracoscopic surgery (66%) and sympatholysis (85%) in this study. Compensatory sweating was 26.4% and, the recurrence rate was 5.7% in the postoperative period. Complications rates were hemothorax 5.6% and pneumothorax 1.8% in the surgery. The third port was required in 5.6% because of adhesions or bleeding or incomplete exploration, and unilateral mini-thoracotomy was required in 9.4% of patients.The average length of stay in the hospital was 3.1 days. Tube thoracostomy increased the length of stay by 1.6 days. The sweating control rate was 96.2% in the early postoperative period. There was no mortality in the patients.
Conclusions: Thoracic sympathetic surgery is successful in the treatment of primary hyperhidrosis and, there is no statistically significant difference between sympathectomy and sympatholysis.
Keywords: Hyperhidrosis, primary, sympathectomy, surgery, treatment
How to Cite
Doolittle J, Walker P, Mills T, et al. Hyperhidrosis: An update on prevalence and severity in the US. Arch Dermatol Res. 2016;308(10):743–749.
Strutton DR, Kowalski JW, Glaser DA, et al: US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: Results from a national survey. J Am Acad Dermatol. 2004;51:241-248.
Lonsdale-Eccles A, Leonard N, Lawrence C. Axillary hyperhidrosis: Eccrine or apocrine? Clin Exp Dermatol 2003;28:2-7.
Mattias AS H, Dorra B, Gregor BE J. Treatment of hyperhidrosis. Am J Clin Dermatol. 2022;23(5):635-646.
Henning MAS, Ibler KS, Loft I, Ostrowski SR, et al. The health-related quality of life in hyperhidrosis and co-morbidities. Qual Life Res; 2022.
Drott C, Gothberg G, Claes G. Endoscopic transthoracic sympathectomy: an efficient and safe method for the treatment of hyperhidrosis. J Am Acad Dermatol. 1995; 33:78–81.
Chiou TS, Chen SC. Intermediate-term results of endoscopic transaxillary T2 sympathectomy for primary palmar hyperhidrosis. Br J Surg. 1999;86:45–47.
Gossot D, Kabiri H, Caliandro R, Debrosse D, Girard P, Grunenwald D. Early complications of thoracic endoscopic sympathectomy: a prospective study of 940 procedures. Ann Thorac Surg. 2001; 71:1116–1119.
Lai YT, Yang LH, Chio CC, Chen HH. Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy. Neurosurgery. 1997;41:110–115.
Kingma R, TenVoorde BJ, Scheffer GJ, Karemaker JM, Mackaay AJ, Wesseling KH, de Lange JJ. Thoracic sympathectomy: effects on hemodynamics and baroreflex control. Clin Auton Res. 2002;12:35–42.
Young O, Neary P, Keaveny TV, Mehigan D, Sheehan S. Evaluation of the impact of transthoracic endoscopic sympathectomy on patients with palmar hyperhidrosis. Eur J Vasc Endovasc Surg. 2003;26:673–676.
Marcelo FAS, Andressa CSL, Marcelo PT, Nickolas S, et al. Population-based analysis of the epidemiology of the surgical correction of hyperhidrosis in 1216 patients over 11 years: A cross-sectional study. Sao Paulo Med J. 2022;140(6):775-780.