| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Cardiothoracic Surgery, Odense University Hospital, Denmark, Sdr Blvd 29, Odense DK-5000, Denmark
(Email: peter.licht{at}ouh.regionsyddanmark.dk).
Patients who seek therapy for primary hyperhidrosis are disabled by their symptoms, and if medical management fails, surgery may be effective. It is generally accepted that upper thoracic sympathectomy is the treatment of choice; this procedure is performed in thousands of patients each year.
Side effects are well known and it is crucial to discuss these thoroughly with the patient before considering sympathectomy. Serious side effects including Horner's syndrome are rare, but patients should be warned that compensatory sweating and decreased heart rate develops in almost everyone. Thus, in the short-term, the key to success in sympathetic surgery lies in meticulous and critical patient selection and thorough information about the high risk of side effects.
For the long term, the key to success in sympathetic surgery lies in more quality research. Li and colleagues [1] are showing the way with an excellent contribution to the literature on sympathetic surgery. During the last 30 years, several hundred retrospective, single institution follow-up series have been published, but we believe that until now there have only been two small randomized trials of 60 and 25 patients, respectively. It is clear that there is no consensus as to which surgical technique is better and which level(s) of the sympathetic chain should be targeted for either palmar, axillary, or facial hyperhidrosis. More than 30 different surgical approaches have been mentioned, which mainly differ between resection, ablation, transection, or clipping of various levels of the sympathetic chain.
Li and colleagues [1] present the third and largest randomized trial of thoracoscopic sympathectomy for palmar hyperhidrosis. The authors randomized 232 patients between an extensive (T2 to T4) and a limited sympathicotomy (T3), both of which are common procedures for palmar hyperhidrosis. Interestingly, the authors could not detect any statistically significant difference in local effect, but patients who had the limited T3 sympathectomy had significantly less severe compensatory sweating at follow-up.
There are two reasons why the present study should have a major clinical impact. First, the authors show that a limited approach does not sacrifice local effect in the palm of the hands and at the same time theoretically eliminates the most feared of complications after sympathectomy, namely Horner's syndrome, because the surgeon does not target the critical higher level of the sympathetic trunk. Second, because compensatory sweating is a major complaint in almost all patients who undergo sympathectomy, the present study shows that a limited resection reduces the severity of this complication.
 |
References |
|---|
 Top References |
|---|
Related Article
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
