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Related Experiment Videos

Thoracoscopic sympathectomy for upper limb hyperhidrosis: looking for the right operation

D Gossot1, L Toledo, S Fritsch

  • 1Department of Surgery, Saint-Louis Hospital, Paris, France. d.gossot@chu-stlouis.fr

The Annals of Thoracic Surgery
|November 14, 1997
PubMed
Summary

Selective rami communicantes division for hyperhidrosis reduces disabling sweating but increases recurrence risk. Further research is needed for an optimal surgical approach balancing efficacy and side effects.

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Area of Science:

  • Thoracic surgery
  • Neurosurgery
  • Dermatology

Background:

  • Thoracoscopic sympathectomy is effective for upper limb hyperhidrosis but causes significant compensatory sweating.
  • A novel technique preserving the sympathetic chain and dividing only rami communicantes was investigated to mitigate side effects.

Purpose of the Study:

  • To compare the efficacy and side effect profile of selective rami communicantes division (Wittmoser technique) versus conventional thoracoscopic sympathectomy for upper limb hyperhidrosis.

Main Methods:

  • 240 thoracoscopic sympathectomies in 124 patients with upper limb hyperhidrosis.
  • Groups included conventional sympathectomy (TS), selective rami communicantes division (SS), and combined (TS/SS).
  • Mean follow-up was 8 months.

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Main Results:

  • No recurrence in group TS; 5% recurrence in group SS (p < 0.05).
  • Similar overall compensatory sweating rates (72.2% TS vs. 70.9% SS).
  • Significantly lower embarrassing/disabling compensatory sweating in group SS (21%) compared to group TS (50%) (p < 0.001).

Conclusions:

  • Selective rami communicantes division reduces disturbing compensatory sweating but increases recurrence rates.
  • The conventional technique shows fewer recurrences but higher rates of disabling side effects.
  • Further investigation is required to develop a surgical technique with both high success and minimal side effects.