|
|
Prospective, Randomized Comparison Between T2 And T3 Thoracoscopic Sympathicotomy For Disabling Palmar Hyperhidrosis
Fritz J. Baumgartner1, Maria Reyes2, Alicia Iglesias2, Elizabeth Reyes2, Grant Sarkisyan1
1Surgery Associates, Los Alamitos, CA;2Doctors Outpatient Surgery Center, Fountain Valley, CA
Prospective, Randomized Comparison between T2 and T3 Thoracoscopic Sympathicotomy for Disabling Palmar Hyperhidrosis
Background- Thoracoscopic sympathetic surgery is highly effective in treating disabling palmar hyperhidrosis. Controversy exists as to the ideal level to maximize efficacy and minimize side effects, most notably compensatory hyperhidrosis (CH). The objective of this study was to compare T2 and T3 sympathicotomy relative to efficacy and side effects in patients with massive palmar hyperhidrosis.
Methods- Prospective randomized study of 124 consecutive patients with disabling palmo-plantar hyperhidrosis assigned to bilateral sympathicotomy (sympathetic transaction) either over the 2nd costal head in 63 patients (n=126 extremities) or 3rd costal head in 61patients (n=122 extremities). Patients were questioned by phone or mail at 6 and 12 months to assess efficacy, side effects, and patient satisfaction relative to the procedure.
Results- Sympathicotomy at T2 was effective in 126/126 (100%) of instances in curing the extremity of palmar hyperhidrosis. Sympathicotomy at T3 failed to cure palmar hyperhidrosis in 3 patients bilaterally (6/122 extremities [5%]). This was significantly less effective than sympathicotomy at the T2 level (P=0.01). Two of the T3 failure patients underwent bilateral redo T2 sympathicotomy procedures with curative results bilaterally. There were no differences in extent or location of CH or patient satisfaction between T2 or T3 groups, nor was there a difference in perceived benefit for plantar hyperhidrosis. Univariate and multivariate analyses at 6 and 12 months showed that presence or severity of CH and patient satisfaction were independent of sympathicotomy level, age, gender, or race. Five (4%) of the 124 patients ranked the CH as extremely bothersome; 3 were T2 and 2 were T3 sympathicotomies. Of these, only 1, a T3 sympathicotomy, stated the CH was life-interfering. No patient regretted the procedure and there were no other side effects or complications.
Conclusion- Sympathicotomy at the T2 level appears to be more reliable than at the T3 level to cure severe palmar hyperhidrosis and does not worsen the extent of CH or patient satisfaction.
Back to 2009 Annual Meeting
Back to Main Program
|
