Recurrent hyperhidrosis after thoracic sympathectomy is an uncomfortable condition, and compensatory hyperhidrosis (CH) is one of the most troublesome side effects. Here, we describe two patients with recurrent palmar hyperhidrosis (PH) and CH over the whole body simultaneously. They were treated with bilateral T4 sympathetic clipping and reconstruction of the sympathetic nerve from a T5 to T8 sympathetic nerve graft, which was transferred to the resected T3 sympathetic bed site. They reported improvements in sweating and were fully satisfied with the results. Our method can be considered as an alternative approach for patients with recurrent PH and CH.
Adult ; Female ; Humans ; Hyperhidrosis/*surgery ; Male ; Recurrence ; Thermography ; Thoracoscopy ; Treatment Outcome

OBJECTIVE: To evaluate the effect of video-assisted thoracoscopic sympathectomy at the T4 level on plantar hyperhidrosis in the treatment of palmoplantar hyperhidrosis.
 METHODS: The clinical data of 28 patients with primary palmoplantar hyperhidrosis, who were admited in our hospital from June 2009 to May 2014, was analyzed. All patients were qualified to bilateral thoracoscopic transaction of the sympathetic chain at the thoracic level T4. Patients completed a self-administered hyperhidrosis questionnaire and scoring before and after procedure. Follow-up data were obtained at 1 and 6 months after the surgery.
 RESULTS: Endoscopic thoracic sympathectomy at the thoracic level T4 was performed successfully for all cases. Palmar hyperhidrosis was completely alleviated after the operation and no recurrence was observed during follow-up. The ratio for initial improvement of plantar hyperhidrosis was 28.6% (8/28) at 1 month after the surgery followed by a recurrence of plantar hyperhidrosis. No case continued to show the improvement of palmoplantar hyperhidrosis at 6 months after the sympathectomy. Twenty-seven patients (96.4%) were very satisfied with the outcome of the operation, 1 patient (3.6%) satisfied and no patient regretted the surgical procedure.
 CONCLUSION T4 thoracoscopic sympathectomy could initialliy alleviate plantar hyperhidrosis in some patients with palmoplantar hyperhidrosis, but the improvement was not sustained over a long period. It could not be used to treat plantar hyperhidrosis.
Foot ; Humans ; Hyperhidrosis ; Recurrence ; Surveys and Questionnaires ; Sympathectomy ; Sympathetic Nervous System ; Thoracic Surgery, Video-Assisted

OBJECTIVE: To assess the quality of life in patients with primary palmar hyperhidrosis before and after T4 endoscopic thoracic sympathicotomy (ETS) using the modified rating scales system for life quality.
 METHODS: Between June, 2009 and May, 2014, forty-eight patients with primary palmar hyperhidrosis received ETS at the thoracic level T4. Patients completed self assessment of life quality by the modified rating scales system before and after the surgery. Follow-up data including effectiveness of operation, patient satisfaction and life quality were obtained at 1 and 6 months after the surgery.
 RESULTS: ETS at the thoracic level T4 was performed successfully for all cases. No mortality or serious complications were observed. No one needed thoracotomy in the period of surgery. Mild or moderate compensatory sweating was appeared in 38 cases (79.1%) or 1 case (2.1%), respectively. None severe case was observed after T4 ETS. About 97.9% of the patients were very satisfied with the result of the operation and no patient regretted the surgical procedure. All patients answered the quality of life (QoL) questionnaire and showed the improvement of QoL after the procedure (F=763.67, P<0.001).
 CONCLUSION Primary palmar hyperhidrosis led to the reduction of life quality. ETS at T4 level could reduce sweating production and improve QoL in patients with primary palmar hyperhidrosis.
Endoscopy ; Humans ; Hyperhidrosis ; surgery ; Patient Satisfaction ; Quality of Life ; Surveys and Questionnaires ; Sweating ; Sympathectomy ; Thoracotomy ; Treatment Outcome

OBJECTIVETo compare the therapeutic effect of traditional and modified apocrine gland removal surgery with the combination of high radiofrequency knife for axillary osmidrosis.

METHODS105 cases (210 sides) were randomly divided into traditional group A (38 cases, 76 sides) and modified group B (67 cases, 134 sides). The wound healing and complications were recorded. The clinical effect was followed up for 6-12 months after operation.

RESULTSNo flap necrosis happened in both groups. The cure rate was 82.89% (63/76)) and 92.54% (124/134) in group A and B, respectively, which was significantly different (P < 0.05). The effective rate of hair removal in group A and B was 42. 1%, 59. 7% (P < 0. 05). There is no markedly difference between the two groups in postoperative hematoma( P >0.05). The recurrence rate in group A and B was 9.21% and 1.49% respectively, with a statistically difference between them (P < 0.05).

CONCLUSIONSModified apocrine gland removal surgery with the combination of high radiofrequency knife can expose the apocrine gland better and the gland, as well as hair, can be removed in the most. The residue hair and recurrency of osmidrosis are very lower.

Adolescent ; Adult ; Apocrine Glands ; surgery ; Catheter Ablation ; instrumentation ; methods ; Female ; Humans ; Hyperhidrosis ; surgery ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

PURPOSE: To observe the evolution of heart rate variability (HRV) in patients with palmar hyperhidrosis before and after endoscopic thoracic sympathotomy and to evaluate the effects of the surgery on the autonomic nervous system. MATERIALS AND METHODS: Endoscopic thoracic sympathotomy was performed on 20 patients with palmar hyperhidrosis. The thoracic sympathetic chain at the level of the third to fourth rib (R3-R4) was transected, but the ganglia were left in position without removal. A slightly larger ramus, in comparison to the other rami, that arose laterally from the sympathetic chain was interrupted to achieve adequate sympathetic denervation of the upper extremity. Before and on the day after the surgery, 24-hour Holter Electrocardiograph was performed, obtaining time domain and frequency domain parameters. RESULTS: Compared with preoperative variables, there was a significant increase in the number of adjacent normal R wave to R wave (R-R) intervals that differed by more than 50 ms, as percent of the total number of normal RR intervals (pNN50); root mean square difference, the square root of the mean of the sum of squared differences between adjacent normal RR intervals over the entire 24-hour recording; standard deviation of the average normal RR interval for all 5-minute segments of a 24-hour recording (SDANN) after thoracic sympathotomy. Low frequencies (LF, 0.04 to 0.15 Hz) decreased significantly. There was no statistical difference in high frequencies (HF, 0.15 to 0.40 Hz), LF/HF ratio (LF/HF), or standard deviation for all normal RR intervals for the entire 24-h recording (SDNN) before and after thoracic sympathotomy. CONCLUSION: There was a significant improvement in HRV in patients with palmar hyperhidrosis after thoracic sympathotomy. This may be attributable to an improvement autonomic nervous system balance and parasympathetic predominance in the early postoperative stage.
Adolescent ; Adult ; Autonomic Nervous System/*surgery ; Electrocardiography ; Female ; Heart Rate/*physiology ; Humans ; Hyperhidrosis/*surgery ; Male ; Thoracic Surgery, Video-Assisted/*methods ; Young Adult

OBJECTIVE: To evaluate the efficiency of video-assisted thoracoscopic surgery for primary palm hyperhidrosis by T4 sympathicotomy plus bypass fiber resection, and to describe our experience regarding the prevention of related postoperative complications. METHODS: Clinical data for 32 cases of primary palmar hyperhidrosis in patients who underwent bilateral video-assisted thoracoscopic sympathictomy plus bypass fiber resection from October 2008 to June 2011 were analyzed retrospectively. RESULTS: The operation was performed successfully on all patients, and their palmar hyperhidrosis was completely alleviated after operation. No severe, surgery-related, postoperative complications occurred. CONCLUSION Video-assisted thoracoscopic sympathictomy is an effective, safe and minimally invasive procedure for primary palmar hyperhidrosis.
Adolescent ; Adult ; Female ; Hand ; Humans ; Hyperhidrosis ; etiology ; surgery ; Nerve Fibers ; Postoperative Complications ; prevention & control ; Sympathectomy ; methods ; Thoracic Surgery, Video-Assisted ; methods ; Young Adult

BACKGROUNDVideo-assisted thoracic sympathetic block is an effective, safe, and minimally invasive method for treatment of primary hyperhidrosis. The purpose of this study was to decide which one of using electrocautery hook and titanium clip is the appropriate procedure for primary palmar hyperhidrosis by assessing the compensatory sweating (CS) and quality of life (QOL) of patients after sympathetic block.

METHODSBetween October 2007 to August 2010, 120 patients with primary palmar hyperhidrosis were randomly divided into two groups, electrocautery hook group (60 patients) and titanium clip group (60 patients). All patients were treated by sympathetic block at T4 level. The CS was graded based on severity and location; the QOL was classified to 5 different levels based upon the summed total scores (range from 20 to 100) before and after surgery. The variables were compared.

RESULTSThe postoperative follow-up period was 2 months. All patients were cured. Three patients in electrocautery hook group and 1 patient in titanium clip group had a unilateral pneumothorax on chest X-ray, but none of them was necessary to have chest drainage. Neither perioperative mortality nor serious complications such as cardiac arrhythmia or arrest were observed during the operation. No bradycardia or Horner's syndrome occured. CS was not more common in patients in titanium clip group than in those in electrocautery hook group (P = 0.001). Moderate and severe CS was few in all patients, and there was no significant difference between two groups (P = 0.193). Most of the patients feel a notable improvement of the the QOL; nevertheless, there was no significant difference between the groups (P = 0.588).

CONCLUSIONSBoth electrocautery hook and titanium clip used for sympathetic block at the T4 level are effective, safe, and minimally invasive for palmar hyperhidrosis. Because of the lower severity of CS and the similar improvements in the QOL after operation, we prefer to use of titanium clip for treating palmar hyperhidrosis.

Adult ; Autonomic Nerve Block ; instrumentation ; methods ; Female ; Humans ; Hyperhidrosis ; surgery ; Male ; Postoperative Complications ; Quality of Life ; Sweating ; physiology ; Sympathetic Nervous System ; surgery ; Titanium ; Treatment Outcome ; Young Adult

We performed sympathetic nerve reconstruction using intercostal nerve in patients with severe compensatory hyperhidrosis after sympathetic surgery for primary hyperhidrosis, and analyzed the surgical results. From February 2004 to August 2007, sympathetic nerve reconstruction using intercostal nerve was performed in 19 patients. The subjected patients presented severe compensatory hyperhidrosis after thoracoscopic sympathetic surgery for primary hyperhidrosis. Reconstruction of sympathetic nerve was performed by thoracoscopic surgery except in 1 patient with severe pleural adhesion. The median interval between the initial sympathetic surgery and sympathetic nerve reconstruction was 47.2 (range: 3.5-110.7) months. Compensatory sweating after the reconstruction surgery improved in 9 patients, and 3 out of them had markedly improved symptoms. Sympathetic nerve reconstruction using intercostal nerve may be one of the useful surgical options for severe compensatory hyperhidrosis following sympathetic surgery for primary hyperhidrosis.
Adult ; Female ; Humans ; Hyperhidrosis/*surgery ; Intercostal Nerves/anatomy & histology/surgery ; Male ; Middle Aged ; Patient Satisfaction ; Quality of Life ; Questionnaires ; Reconstructive Surgical Procedures/*methods ; Sympathetic Nervous System/anatomy & histology/*surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo compare the efficacy of decollement, combined tumescent liposuction and curettage, Botox injection in the treatment of osmidrosis.

METHODSFrom September 2006 to April 2009, 350 patients with osmidrosis were treated by decollement method in 180 cases, curettage in 120 cases,and Botox injection in 50 cases. The therapeutic effect and complications were retrospectively analyzed.

RESULTSThe patients were followed up for 3-24 months. The cure rate was 90.6%, 84.8% and 84.2% in decollement, curettage and Botox groups, respectively. The effective rate was 100% in all groups.

CONCLUSIONSAll the three methods are effective for the treatment of osmidrosis. The odor symptom can be improved a lot with decollement method. Considering the complication, downtime and cosmetic results, Botox injection is suitable for patients with minor or median odor, while combined liposuction and curettage is selected for patients with median to severe odor.

Axilla ; surgery ; Botulinum Toxins, Type A ; administration & dosage ; therapeutic use ; Curettage ; methods ; Female ; Follow-Up Studies ; Humans ; Hyperhidrosis ; surgery ; Lipectomy ; methods ; Male ; Retrospective Studies ; Treatment Outcome

BACKGROUNDVideo-assisted thoracoscopic sympathectomy had replaced open surgery. The aim of this study was to compare the outcomes of using a single port and two ports to perform video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis.

METHODSBetween April 2006 and February 2008, 20 cases underwent video-assisted thoracoscopic sympathectomy through one port (uniportal group) and 25 cases through two ports (biportal group). The variables including the operating time, hospital stay, pain scores, postoperative complications, incidence of symptom recurrence and patient satisfaction were compared. The mean postoperative follow-up period was 11.5 months (range, 3 - 25 months).

RESULTSThe hands of all patients were warm and dry after operation. No conversion to open surgery was necessary, and no operative mortality was recorded in either group. The mean inpatient pain scores were significantly higher in the biportal group (1.2 +/- 0.6) than that in the uniportal group (0.8 +/- 0.5, P = 0.025). For the first three weeks after operation, four out of 20 (20%) patients in the uniportal group constantly suffered from mild or moderate residual pain while eight out of 25 (32%) cases in the biportal group (P = 0.366). Among them, two cases in the uniportal group and five cases in the biportal group need to take analgesics. Our mean operative time (bilateral sympathectomy) in the uniportal group ((39.5 +/- 10.0) minutes) was shorter than that in biportal group ((49.7 +/- 10.6) minutes, P = 0.02). There were no significant differences between two groups in terms of the mean hospital stay, compensatory sweating, and patient satisfaction. Two patients in the biportal group and three in the uniportal group experienced a unilateral pneumothorax. None of them required chest drainage. No patient experienced Horner's syndrome, and no recurrent symptoms were observed in either groups.

CONCLUSIONSBoth uniportal and biportal video-assisted thoracoscopic sympathectomy are effective, safe, and minimally invasive for palmar hyperhidrosis. Comparing with the biportal approach, the uniportal approach causes less postoperative pain and less operative time, and is a more reasonable procedure in treatment of palmar hyperhidrosis.

Adult ; Female ; Hand ; surgery ; Humans ; Hyperhidrosis ; surgery ; Male ; Sympathectomy ; methods ; Thoracic Surgery, Video-Assisted ; methods