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| Objective Assessment Of Sudomotor Response Following Thoracoscopic Sympathectomy |
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Back to 86th Annual Meeting Back to Program Outline Objective: Thoracoscopic sympathectomy has become an accepted therapeutic option for palmar hyperhidrosis. Most of the current literature analyses subjective outcomes as reported by patients in terms of satisfaction. However, no long term objective assessment of sweat output following sympathectomy has been reported so far. We report for the first time a sweat output measurements following sympathectomy over three year period post-operatively. Methods: Thoracoscopic sympathectomy was performed by division of T2 and T3 sympathetic ganglia in 17 healthy adult patients (age between 20 and 30years) with no co-morbidities. Pre-operative and post-operative sweat measurement was done at 290 C (below sweat threshold, at baseline, after verbal chat and after a mental arithmetic challenge) and 400 C (baseline and after exercise) by continuous write out of water content of gas which has perfused over skin under capsule (sweat measured in ug/cm2skin/min) in left palm, sole and chest wall. Serial measurements post-operatively were conducted at 1mth, 6mth, 1yr, 2yr and 3 yr interval. Results: As expected the sweat output fell significantly after sympathectomy compared to pre-op levels under all experimental conditions (p<001, ANOVA) in the left palm. Sweat output was statistically significant between groups at baseline and post-operatively following mental arithmetic challenge and exercise at 400 C (p<0.05, ANOVA) in the left palm (Figure). Compensatory increase in the sweat output from left sole and chest was observed following sympathectomy after mental arithmetic challenge, at 400 C and after exercise when compared to baseline. None of the patients had return of pre-operative values of sweat output when followed up. Conclusions: These data demonstrate objective sweat output measurements after thoracoscopic sympathectomy results in a long term control of palmar hyperhidrosis. This evaluation method is valuable in investigating recurrence of symptoms or compensatory hyperhidrosis following sympathectomy providing a robust and objective criteria for planning intervention. 
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