CLINICAL STUDY OF THORACOSCOPIC AND OPEN CERVICAL SYMPATHECTOMY IN TREATMENT OF PRIMARY HYPERHIDEROSIS OF THE HAND

Abstract

Primary palmer hyperhidrosis has been treated with variety of medical treatments, with varying degree of success. Several methods of medical treatments have been tried including lotions, perispirants, oral medications, iontophoresis and botulinium toxins, proved to have minimal and temporary effect. Thoracic sympathectomy has evolved as a treatment option for patients with hyperhidrosis. In the past years, several open surgical procedures were used which were, highly invasive and cause significant morbidity. The minimally invasive thoracoscopic procedure has been developed which provides, detailed visualization of the sympathetic ganglia and is associated with minimal post­ operative morbidity. We performed thoracoscopic sympathectomy in 24 patients (all have severe palmer hyperhidrosis with social problems), with mean age of 23 years old. We performed both sides, at the same time in most patients (all patients have been done bilaterally except one i.e. 24 patients in 25 cessions). Another 10 patients, with mean age of 24.7 years old, were done with open procedures (usually performed in 2 separate occasions in most patients, i.e. 10 patients in 18 cessions). Data of pre and intraoperative as will as postoperative follow up has been collected and analyzed. The outcomes were nearly equivalent (considering the fast and permanent effect in the relief of hyperhidrosis) for those patients done with thoracoscopic method and those with open surgical techniques; however, the rate of surgery-related morbidity (intraoperative problems), length of hospital stay, and time until return to normal activity were substantially reduced in thoracoscope. Overall patient satisfaction with the operative treatment (either open or thoracoscopic) was high in most of the patients. Complications are nearly the same except that related to the big wound and difficult access in the open surgical techniques. Early complications include haemothorx, residual pneumothorax (requiring chest drainage), postoperative pain and wound infection, which all were less in thoracoscope