Objective evaluation of plantar hyperhidrosis after sympathectomy

OBJECTIVE: The aim of the present study was to prospectively, randomly, blindly, and objectively investigate how surgery affects plantar sudoresis in patients with palmar and plantar hyperhidrosis over a one-year period using a sudorometer (VapoMeter). METHODS: From February 2007 to May 2009, 40 consecutive patients with combined palmar hyperhidrosis and plantar hyperhidrosis underwent video-assisted thoracic sympathectomy at the T3 or T4 ganglion level (15 women and 25 men, with a mean age of 25 years). RESULTS: Immediately after the operation and during the one-year follow-up, all of the patients were free from palmar hyperhidrosis episodes. Compensatory hyperhidrosis of varying degrees was observed in 35 (87.5%) patients after one year. Only two (2.5%) patients suffered from severe compensatory hyperhidrosis. There was a large initial improvement in plantar hyperhidrosis in 46.25% of the cases, followed by a progressive regression of that improvement, such that only 30% continued to show this improvement after one year. The proportion of patients whose condition worsened increased progressively (from 21.25% to 47.50%), and the proportion of stable patients decreased (32.5% to 22.50%). This was not related to resection level; however, a lower intensity of plantar hyperhidrosis prior to sympathectomy correlated with worse evolution. CONCLUSION: Patients with palmar hyperhidrosis and plantar hyperhidrosis who underwent video-assisted thoracic sympathectomy to treat their palmar hyperhidrosis exhibited good initial improvement in plantar hyperhidrosis, which then decreased to lesser degrees of improvement over a one-year period following the surgery. For this reason, video-assisted thoracic sympathectomy should not be performed when only plantar hyperhidrosis is present.

Long-term outcomes associated to video-assisted thoracic sympathotomy for palmar-axillar subtype of the hyperhidrosis / Resultados tardios da simpatotomia torácica vídeo-assistida para tratamento do subtipo palmar-axilar de hiperidrose

OBJECTIVE: Surgery for both palmar and axillar hyperhidrosis usually includes the interruption of the sympathetic chain in multiple levels. This study aimed to determine the long-term outcomes associated to video-assisted thoracic sympathotomy (VATS) of T2, T3 and T4 ganglia for these cases. METHODS: Analysis of the outcomes obtained from 36 patients regarding the rate of resolution of the symptoms and the compensatory sweating (CS). All subjects were followed-up for 36 months. RESULTS: Good outcomes were observed in 98.6% for palmar and 60% for axillary hyperhidrosis (p=0.0423), respectively. Of the subjects, 86% reported some postoperative episode of CS, however only 45% (p=0.0031) still noticed it at the end of the follow-up period. CONCLUSIONS: VATS is effective for the excessive palmar sweating, whereas it is fully efficient for only two thirds of the cases sustaining associated axillar hyperhidrosis. CS is expected as a rule following the proposed operative protocol, however it is usually self-limited.

OBJETIVO: A cirurgia para hiperidrose palmar e axilar usualmente inclui a interrupção da cadeia simpático-torácica em múltiplos níveis. Este estudo objetivou apresentar os resultados tardios associados à simpatectomia torácica vídeo-assistida (STVA) dos gânglios T2,T3 e T4 nesses casos. MÉTODOS: Foram analisados os resultados cirúrgicos obtidos em 36 pacientes quanto à taxa de resolução dos sintomas e à ocorrência de hiperidrose compensatória (HC). Todos os sujeitos foram acompanhados por 36 meses. RESULTADOS: Bons resultados foram observados em 98,6% dos pacientes para a forma palmar e em 60% para a forma axilar (p=0,0423). Em 86% dos casos, havia relato de algum episódio de HC, mas apenas 45% ainda notavam sua ocorrência ao final do período de acompanhamento. CONCLUSÕES: A STVA é eficaz para o tratamento da hiperidrose palmar, mas mostrou-se plenamente satisfatória em apenas dois terços dos casos associados à forma axilar. A HC deve ser considerada ocorrência esperada no protocolo cirúrgico; no entanto, evolui de maneira autolimitada na maioria dos casos.