Long-Term Effect of Endoscopic Sympathetic Nerve Reconstruction for Side Effects after Endoscopic Sympathectomy

Abstract

Background Endoscopic thoracic sympathectomy (ETS) is an effective treatment for primary hyperhidrosis. However, compensatory sweating (CS) may occur in many patients. Sympathetic nerve reconstruction (SNR) can be used to counteract severe CS, but the studies on the effects of SNR are few.

Patients and Methods Nineteen out of 150 SNR patients were contacted by employing a long-term questionnaire. In this questionnaire, different kinds of sweating were evaluated using a four-graded symptom analysis and the visual analog scale before ETS, after ETS, and after SNR.

Results The mean age of the 16 male and 3 female patients at the SNR was 32 years. The mean follow-up was 87 months. According to the long-term questionnaire, the benefit was either excellent (4 patients, 21%), good (3 patients, 15.8%), or reasonable (7 patients, 36.8%) in 14 patients (73.8%), while the benefit was questionable in 1 patient (5.3%). For three patients (15.8%), no benefit was found, and in one patient (5.3%), the situation had deteriorated.

Conclusions Improvement in the side effects of ETS after SNR was found in nearly 75% of the patients. This indicates that SNR can be considered as an alternative treatment for patients with severe CS after ETS that is unresponsive to conservative treatment.

Keywords

endoscopic thoracic sympathectomy - side effects - sympathetic nerve reconstruction - long-term results

• References

• 1 Jadresic E, Súarez C, Palacios E, Palacios F, Matus P. Evaluating the efficacy of endoscopic thoracic sympathectomy for generalized social anxiety disorder with blushing complaints: a comparison with sertraline and no treatment-Santiago de Chile 2003-2009. Innov Clin Neurosci 2011; 8 (11) 24-35
• 2 Coveliers H, Atif S, Rauwerda J, Wisselink W. Endoscopic thoracic sympathectomy: long-term results for treatment of upper limb hyperhidrosis and facial blushing. Acta Chir Belg 2011; 111 (05) 293-297
• 3 Smidfelt K, Drott C. Late results of endoscopic thoracic sympathectomy for hyperhidrosis and facial blushing. Br J Surg 2011; 98 (12) 1719-1724
• 4 Bachmann K, Standl N, Kaifi J. , et al. Thoracoscopic sympathectomy for palmar and axillary hyperhidrosis: four-year outcome and quality of life after bilateral 5-mm dual port approach. Surg Endosc 2009; 23 (07) 1587-1593
• 5 Costa Jr AdaS, Leão LE, Succi JE. , et al. Randomized trial - oxybutynin for treatment of persistent plantar hyperhidrosis in women after sympathectomy. Clinics (Sao Paulo) 2014; 69 (02) 101-105
• 6 Gong TK, Kim W. Effectiveness of oral glycopyrrolate use in compensatory hyperhidrosis patients. Korean J Pain 2013; 26 (01) 89-93
• 7 Santana-Rodríguez N, Clavo B, Calatayud-Gastardi J. , et al. Severe compensatory hyperhidrosis following thoracic sympathectomy successfully treated with low doses of botulinum toxin A. J Dermatolog Treat 2012; 23 (06) 457-460
• 8 Stefaniak T, Cwigon M, Łaski D. In the search for the treatment of compensatory sweating. Sci World J 2012; 2012: 134547
• 9 Telaranta T. Secondary sympathetic chain reconstruction after endoscopic thoracic sympathicotomy. Eur J Surg Suppl 1998; 580 (580) 17-18
• 10 Haam SJ, Park SY, Paik HC, Lee DY. Sympathetic nerve reconstruction for compensatory hyperhidrosis after sympathetic surgery for primary hyperhidrosis. J Korean Med Sci 2010; 25 (04) 597-601
• 11 Rantanen T, Telaranta T. Long-term results of endoscopic sympathetic block using the Lin-Telaranta classification. Surg Endosc 2013; 27 (10) 3860-3864
• 12 Davidson JR, Miner CM, De Veaugh-Geiss J, Tupler LA, Colket JT, Potts NL. The brief social phobia scale: a psychometric evaluation. Psychol Med 1997; 27 (01) 161-166
• 13 Taiminen T. Sosiaalisten tilanteiden pelon hoito [in English]. Duodecim 1998; 114 (01) 73-79
• 14 Reading A. Testing pain mechanisms in persons in pain. In: Wall P, Melzack R. eds. Textbook of Pain. 2nd ed. New York: Churchill Livingstone Inc; 1989: 269-280
• 15 Lin CC, Mo LR, Lee LS, Ng SM, Hwang MH. Thoracoscopic T2-sympathetic block by clipping—a better and reversible operation for treatment of hyperhidrosis palmaris: experience with 326 cases. Eur J Surg Suppl 1998; 580 (580) 13-16
• 16 Sugimura H, Spratt EH, Compeau CG, Kattail D, Shargall Y. Thoracoscopic sympathetic clipping for hyperhidrosis: long-term results and reversibility. J Thorac Cardiovasc Surg 2009; 137 (06) 1370-1376 , discussion 1376–1377
• 17 Coelho MdeS, Silva RF, Mezzalira G. , et al. T3T4 endoscopic sympathetic blockade versus T3T4 video thoracoscopic sympathectomy in the treatment of axillary hyperhidrosis. Ann Thorac Surg 2009; 88 (06) 1780-1785
• 18 Yanagihara TK, Ibrahimiye A, Harris C, Hirsch J, Gorenstein LA. Analysis of clamping versus cutting of T3 sympathetic nerve for severe palmar hyperhidrosis. J Thorac Cardiovasc Surg 2010; 140 (05) 984-989
• 19 Neumayer C, Zacherl J, Holak G. , et al. Limited endoscopic thoracic sympathetic block for hyperhidrosis of the upper limb: reduction of compensatory sweating by clipping T4. Surg Endosc 2004; 18 (01) 152-156
• 20 Reisfeld R. Sympathectomy for hyperhidrosis: should we place the clamps at T2-T3 or T3-T4?. Clin Auton Res 2006; 16 (06) 384-389
• 21 Loscertales J, Congregado M, Jimenez-Merchan R. , et al. Sympathetic chain clipping for hyperhidrosis is not a reversible procedure. Surg Endosc 2012; 26 (05) 1258-1263