Document Detail

Severe hyperhidrosis: clinical features and current thoracoscopic surgical management.
MedLine Citation:
PMID:  14667604     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Severe hyperhidrosis is a debilitating disorder primarily affecting the palmar, plantar, and axillary regions. The purpose of our study was to review patient characteristics, surgical technique, and outcome of patients undergoing outpatient thoracoscopic sympathectomy for severe hyperhidrosis. METHODS: A series of 309 hyperhidrosis patients underwent thoracoscopy for T2-T3 sympathectomy. Of these, 180 underwent prospective evaluation to more precisely identify pre- and postoperative features. RESULTS: The primary indication for surgery was palmar hyperhidrosis (PH) in 302 of 309 patients (97.7%), although in 7 patients (2.3%) axillary hyperhidrosis (AH) was the primary indication. A family history was elicited in 74 of 132 (56.1%) and a provocative response to hand lotion was present in 101 of 132 (76.5%). Thoracoscopic sympathectomy afforded almost instantaneous cures for PH, with marked improvement in 100% for whom the sympathectomy was done. Of 180 patients prospectively questioned in detail, 173 (96.1%) had some degree of plantar hyperhidrosis. Of these, 148 (84.4%) had some improvement, with 70 (40.5%) achieving complete relief of the plantar hyperhidrosis. In 98 patients who had some complaints of AH, 68 (69.4%) were completely relieved of the AH, while 25 (25.5%) were relieved but not completely cured. In 7 patients, the primary indication for sympathectomy was AH and of these, 3 (42.9%) had complete relief, 2 (28.6%) had partial relief, and 2 (28.6%) had no relief. Of the entire series of 309 patients, 4 (1.3%) developed severe compensatory hyperhidrosis (CH). In 180 prospectively questioned patients, CH was present in 81 (45%). CONCLUSIONS: The most frequent presentation of hyperhidrosis involves the hands and feet. A family history of the disorder is common, and there is usually a provocative effect with hand lotion. Sympathectomy at the level of the T2-T3 ganglia is curative for PH, and in 80% of instances will improve plantar hyperhidrosis when in combination with PH. Sympathectomy for AH is not as effective as for PH. CH is common, occurring in nearly half, but only rarely is extreme and problematic. Bilateral thoracoscopic sympathectomy may be safely done as an outpatient procedure for most patients.
Fritz J Baumgartner; Youn Toh
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  76     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2003-12-11     Completed Date:  2004-01-16     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1878-83     Citation Subset:  AIM; IM    
Center for the Cure of Sweaty Palms, Santa Ana, California, USA.
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MeSH Terms
Hyperhidrosis / diagnosis,  surgery*
Middle Aged

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