Hiroshi Sugimura, Ernst H. Spratt, Christopher G. Compeau, Yaron Shargall; Division of Thoracic Surgery, Department of Suregry, University of Toronto, St. Joseph's Health Centre, Toronto, ON, Canada
Objective: 1.To assess post-operative satisfaction and occurrence of compensatory sweating following thoracoscopic sympathetic clipping (TSC). 2. To assess the reversibility of adverse effects by removal of surgical clips.Methods: Between June 1998 and March 2006, 727 patients undergoing bilateral TSC for hyperhidrosis (HH) or facial blushing were prospectively followed for post-operative satisfaction and subjective compensatory sweating (CS). The effect of removal of surgical clips was assessed in patients who underwent a subsequent reversal procedure. Satisfaction and compensatory sweating (CS) were assessed using a visual analogue scale.
Results: Follow-up was complete in 666 patients (92%). The median age was 27 years (range 14-65).The level of sympathetic clipping was T2 in 399 (55%), T2+3 in 55 (8%), and T3+4 in 273 (38%) patients. Median follow-up was 10.4 months (range 0-79). Excellent satisfaction was seen at last follow-up in 288 (74%) of the T2, 33 (62%) of the T2+3, and in 184 (85%) of the T3+4 group. Post-operative satisfaction was significantly higher in the T3+4 group when compared to the T2 or T2+3 groups (p<0.01). Severe CS was reported in 42(13%) of the T2, 11 (28%) of the T2+3, and in 17(8%) of the T3+4 groups. The proportion of patients with severe CS was significantly higher in the T2 or T2+3 group when compared to the T3+4 group (p<0.05). Thirty-four patients have subsequently undergone removal of the surgical clips after TSC. Follow-up was complete in 30 patients. The reversal was done after a median time of 9.5 months (range 1-56) following TSC. The initial level of clipping was T2 in 21, T2+3 in 7, and T3+4 in 6 patients. There was a trend toward fewer subsequent reversal procedures in the T3+4 group when compared to the T2 or T2+3 groups (p=0.06). Fifteen patients reported substantial decrease in their CS after reversal. Ten patients reported that their initial HH or facial blushing have remained well controlled after reversal. There was no relationship between reversibility of symptoms, original level of clipping and the interval between TSC and subsequent reversal.
Conclusion: When compared to TSC at the T2 or T2+3 levels, TSC at the T3+4 level was associated with higher satisfaction rate, lower rate of severe CS, and a trend toward fewer subsequent reversal procedures.While yet to be supported by electrophysiological studies, reversal of sympathetic clipping seems to provide with an acceptable results, and should be considered in selected patients.
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