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| Retrospective Analysis of Two Endoscopic Thoracic Sympathectomy Techniques for Palmar Hyperhidrosis: Clamping versus Cutting of the Sympathetic Chain | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Ali N. Ibrahimiye1, Ted Yanagihara3, Alan Weinberg2, Joy Hirsch3, Catherine R. Harris4, Lyall Gorenstein1; 1Surgery, Columbia University College of Physicians and Surgeons, New York, NY; 2Biostatistics, Columbia University College of Physicians and Surgeons, New York, NY; 3Neuroscience, Columbia University College of Physicians and Surgeons, New York, NY; 4Surgery, University of California San Francisco, San Francisco, CA Objective: Endoscopic Thoracic Sympathectomy (ETS) at the T3 level is one of the surgical treatment options that can eliminate the disabling symptoms of palmar hyperhidrosis. To date , several studies have shown good results when clamping at various levels and some have contrasted the effects of cutting and clamping at multiple thoracic levels, but to our knowledge no single institution studies have directly compared the effects of cutting versus clamping when the sympathectomy is restricted to T3. We quantified and compared pre- and post-surgical subjective sweat production in different areas of the body and changes in quality of life , accounting for both benefits and side effects with clamping versus cutting of the sympathetic chain at T3 level. Methods: Patients seen between June 30, 2003 and March 16, 2007 were asked to quantify the severity of their symptoms before and after endoscopic thoracic sympathectomy. Interviews were conducted approximately one year following the procedure and only patients receiving sympathectomy at level T3 for a chief complaint of palmar hyperhidrosis were included in the analysis (n=153). In 45% of these, clamping of the sympathetic chain was performed while the remaining 55% had the chain ablated. Results: Following surgery, 77% of patients experienced no hand sweating, 20% reported mild or normal sweating. No patients had continued excessive sweating of the hands. Ninety-six percent of patients were satisfied with the results. Coincidental decrease in sweating also occurred in other area of the body: feet (63%), axilla (60%). Compensatory sweating was experienced on at least one part of the body by 87% of patients and was severe in 4% of patients. There was no difference in outcome between patients having clamping versus cutting of the sympathetic chain [table1]. Conclusion: We found high rates of success and patient satisfaction when T3 sympathectomy was performed for palmar hyperhidrosis. In all of the same outcome measures we found no differences between cutting and clamping techniques. Comparison of cutting vs. clamping of sympathetic chain
The data indicate no significant difference between cutting and clamping of the sympathetic chain across all parameters, including the resolution of hand sweating (p=0.148), the appearance of CS on the trunk (p=0.728) or thighs (p=0.229)and rates of patient satisfaction (p=0.741). Back to 2010 Annual Meeting Back to Program Outline Back to Main Program |
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