Thoracoscopic Sympathetic Surgery for Axillary Hyperhidrosis

Hong, Yoon Joo; Lee, Doo Yun; Paik, Hyo Chae; Shin, Hwa Gyun; Hwang, Jung Joo; Jung, Eun Gyu

Abstract

BACKGROUND: Recent development of endoscopic devices and surgical techniques enabled the video-assisted thoracoscopic sympathetic surgery to be reliable, safe and minimally invasive for the treatment of hyperhidrosis. People with axillary hyperhidrosis, however, were not as satisfied as those with palmar or craniofacial hyperhidrosis due to more frequent and severe compensatory sweating and lack of effect on concomitant osmidrosis. MATERIAL AND METHOD: From March 1997 through April 1999, 45 cases of axillary hyperhidrosis underwent T3,4 sympathectomy(21 patients), T2,4 sympathicotomy(20 patients) or T4 sympathectomy(4 patients). We evaluated and analyzed the early effect of symptomatic relief, compensatory hyperhidrosis and the level of long term satisfaction. The sex ratio was 28 males: 17 females with an average age of 28 years, ranging from 13 to 46 years. Two patients had concomitant osmidrosis and one patient who underwent T3,4 sympathectomy experienced profuse compensatory sweating on face and scalp for which he underwent a reoperation of T2 sympathicotomy 93 days later. All the procedures were performed under general anesthesia in semifowler's position with 30 elevation of the upper body. A 2mm needle thoracoscope was used except in 2 cases with moderate to severe pleural adhesions where a 5mm thoracoscope was used. RESULT: Average operation time was 46.2+/-11 minutes for T3,4 sympathectomy; 32.5+/-23 minutes for T2,4 sympathicotomy; and 53.8+/-18 minutes for T4 sympathectomy. Every patient who underwent T3,4 sympathectomy and T2,4 sympathicotomy showed satisfaction 17 cases(81%) and 12 cases(60%) had absolutely no sweating after T3,4 sympathectomy and T2,4 sympathicotomy, respectively and the remaining 4 cases(19%) and 8 cases(40%) experienced 'decreased amount of sweating with slightly moist armpits'. Compensatory hyperhidrosis was present in 67% and 60% of the cases after T3,4 sympathectomy and T2,4 sympathicotomy, but only 10% and 5 %, were severe enough to be embarrassing or disabling. The level of satisfaction was high in both groups, with 86% after T3,4 sympathectomy and 89% after T2,4 sympathicotomy.
CONCLUSION
Both T3,4 sympathectomy and T2,4 sympathicotomy were effective means of treating axillary hyperhidrosis. T3,4 sympathectomy had superior symptomatic relief although T2,4 sympathicotomy was favored because of shorter operation time, easier surgical technique and milder compensatory sweating. Long term satisfaction level, however, was similar in both groups.