Thoracoscopic Sympathectomy for Primary Hyperhidrosis: A Two-year Experience at Police General Hospital
Thoracoscopic sympathectomy is currently the most acceptable surgical treatment for disabling upper limb hyperhidrosis. The procedure is known and had been performed by a very few surgeons in Thailand. The results were never been reported except from our institute.
Objective: To quantitatively evaluate the results of treatment of primary hyperhidrosis with thoracoscopic sympathectomy in our two years experience at Police General Hospital.
Materials and Methods: Two hundred and nine thoracoscopic sympathectomies had been performed for 105 consecutive patients suffered from primary hyperhidrosis during February 1998 to May 2000. To evaluate the results of treatment, side effects, complications, quality of life and satisfaction to the treatment, questionnaires as a form of Linear analogue score was mailed to patients. There were seventy two patients responded to questionnaires and were included to this study.
Statistical Analysis: Linear analogue score with the Student's t test was used for statistical analysis.
Results: Palmar sweating was reduced from a mean score of 9.224 pre-operatively to 0.528 after sympathectomy (P<0.001). For axillae :4.7200 to 3.6900 after T2 sympathectomy(NS) and 8.600 to 3.111 after T2+T3 sympathectomy (P <0.001). Sixty one patients (84.7%) felt their quality of life was markedly improved after the operation, while six (8.3%) felt worsen. Compensatory sweating occurred in more than ninety percent of the patients which was the main cause of dissatisfaction (16.7%) and worsen quality of life (8.3%) in this group. Minor complications occurred in a few patients without major postoperative consequence.
Conclusions: Thoracoscopic sympathectomy is safe and effective for the treatment of primary hyper hidrosis especially for the upper limb. However, compensatory sweating does occur in a significant number of patients and is the cause of dissatisfaction to the treatment in some patients. T2+T3 sympathectomy seems promising to treat severe concomitant axillary hyperhidrosis. Patients should be clearly informed of postoperative compensatory sweating before the operation.
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