ABSTRACT
Introducción: la hiperhidrosis primaria es una enfermedad benigna que consiste en la excesiva producción de sudor, principalmente en manos, axilas y pies, y por ello puede llegar a condicionar la vida social y laboral de quien la padece. Objetivo: evaluar los resultados de la técnica simpaticotomía videotoracoscópica por un solo puerto usando oxigenación apneica para lograr el colapso pulmonar. Métodos: estudio descriptivo y transversal a 37 niños operados de enero de 2011 a junio de 2012, con edades comprendidas entre los 11 y 18 años, en el Hospital Pediátrico Universitario de Centro Habana, a los que se analizó: edad, sexo, complicaciones, estadía y grado de satisfacción. Resultados: todos los pacientes tenían las edades mencionadas, fue más frecuente en las hembras (22, 59,5 %), con resultados inmediatos en 36 pacientes (97,3 %), y sequedad e incremento de la temperatura de las manos al finalizar cada hemitórax. No se usaron sonda pleural ni antibióticos posoperatorios. No hubo complicaciones, y la estadía fue corta (97,3 %). El sudor compensatorio se dio en 9 pacientes (24,3 %), y el índice de satisfacción fue del 100 %. Conclusiones: esta técnica quirúrgica pudiera ser una opción terapéutica eficaz para mejorar la calidad de vida desde edades tempranas.
Introduction: primary hyperhidrosis is a benign disease that consists of the overproduction of sweating mainly in hands, axillae and feet, which may affect the social and work life of those people who suffer it. Objectives: to evaluate the results of the videothoracoscopic sympathicotomy using apneic oxygenation to reach the pulmonary collapse. Methods: cross-sectional and descriptive study of 37 children aged 11 to 18 years, who were operated on from January 2011 to June 2012 at the university pediatric hospital of Centro Habana. The analyzed variables were sex, age, complications, length of stay at hospital and level of satisfaction. Results: the disease was more frequent in females (22 for 59.5 %). Immediate positive results were achieved in 36 patients (97.3 %); dryness and increase of temperature in hands were found on finishing each hemithorax. Neither postoperative pleural tube nor antibiotics were used. There were no complications, the length of stay was short (97.3 %). The compensatory sweating was seen in 9 patients (24.3 %) and the satisfaction index was 100 %. Conclusions: this surgical technique could be an effective therapeutic option to improve the quality of life at earlier ages.
ABSTRACT
Endoscopic thoracoscopic sympathicotomy (ETS) for treatment of hyperhidrosis is usually considered as a simple and safe procedure. The complication of ETS is low and no death following ETS has ever been reported in the literature without anecdotal fatal cases. Recently, we experienced two cases of intraoperative cardiac arrest and death. Two patients are suffered from sudden cardiac arrest after transection of the left sympathetic nerve trunk by the thoracoscopic method. Vigorous cardiopulmonary resuscitations were performed but both patients are not recovered. Autopsy examinations are performed and there are no remarkable pathology.
ABSTRACT
BACKGROUND: Thoracoscopic Sympathicotomy (TS) is widely accepted as an effective method for the treatment of palmar hyperhidrosis. Single lumen endotracheal tube using CO2 insufflation is a simple and safe method for thoracoscopic surgery. However, there are chances of CO2 embolism during CO2 insufflation and nerve dissection. The object of this study were to assess the incidence of embolic events using transesophageal echocardiography (TEE) and to evaluate the related cardiorespiratory consequence during TS. METHODS: Thirty-two patients undergoing TS were studied. The long axis four chamber view was obtained continuously, except for predetermined intervals (after induction, CO2 insufflation in left thoracic cavity, left sympathicotomy, CO2 insufflation in right thoracic cavity, and right sympathicotomy) where the transgastric short axis view was obtained to derive ejection fraction (EF). Heart rate, mean arterial pressure (MAP), O2 saturation, and end tidal CO2 were monitored. Statistical analysis was performed using multivariated ANOVA and unpaired Student's t-test. P < 0.05 was considered significant. RESULTS: We observed CO2 embolism in 28/32 patients during CO2 insufflation (left or right) and in 32/32 patients during nerve dissection (left or right). There was no significant difference in cardiorespiratory variables between patients who presented embolism and who did not, during four distinct periods of events. Meanwhile, MAP decrease (P = 0.002) and EF increased significantly (P = 0.007) after sympathicotomy. This can be explained by decrease in systemic vascular resistance (SVR) by sympathicotomy. CONCLUSIONS: Embolic events commonly occur during CO2 insufflation and nerve dissection without cardiorespiratory instability during TS. However, we should pay attention when administrating N2O.
Subject(s)
Humans , Arterial Pressure , Axis, Cervical Vertebra , Carbon Dioxide , Carbon , Echocardiography, Transesophageal , Embolism , Heart Rate , Hyperhidrosis , Incidence , Insufflation , Thoracic Cavity , Thoracoscopy , Vascular ResistanceABSTRACT
OBJECTIVE: Thoracoscopic sympathicotomy is effective in treating not only palmar hyperhidrosis, but also axillary hyperhidrosis. But studies for axillary hyperhidrosis accompanying osmidrosis are few. We report the outcome of six axillary hyperhidrosis with osmidrosis with literatures review. METHODS: Using a minimally invasive technique, thoracoscopic T3-4 sympathicotomy was performed. The results of sympathicotomy of third and fourth sympathetic chains of six patients from January 1999 to August 2003 for axillary hyperhidrosis with osmidrosis were reviewed. RESULTS: All patients had a successful outcomes, their profuse sweating ceased. Two patients suffered from compensatory hyperhidrosis. Three patients disappeared or diminished foul odor but three patients complained remained osmidrosis. CONCLUSION: In the treatment of axillary hyperhidrosis, the sympathicotomy of T3 and T4 chain is an effective method but osmidrosis must be treated according to its cause.