Treatment outcomes and objectification methods of the thoracoscopic sympathectomy in patients with focal hyperhidrosis and blushing syndrome

Authors

DOI:

https://doi.org/10.25305/unj.227762

Keywords:

hyperhidrosis, sympathectomy, blushing syndrome, TEWL-metry, capillaroscopy, quality of life

Abstract

Uniportal video-assisted thoracoscopic sympathectomy (VATS) is an effective minimally invasive surgical method of choice for the treatment of primary focal hyperhidrosis and blushing syndrome due to uncontrolled operation of the sympathetic nervous system.

The aim of this study was to provide an objective assessment of the improvement in the quality of life of patients with primary focal hyperhidrosis and blushing syndrome after bilateral monoport video-assisted thoracoscopic sympathectomy.

Materials and methods. The results of surgical treatment were performed for 62 patients aged 17 to 42 years, 26 men and 36 women with a diagnosis of primary focal hyperhidrosis of the extremities and blushing syndrome. All patients underwent bilateral uniport video-assisted thoracoscopic sympathectomy. Patients are divided into 3 groups depending on the level of coagulation of the sympathetic trunk: the first group of the study (n = 9) includes patients after bilateral uniport sympathectomy at the level of R3 (isolated palmar hyperhidrosis), the second (n = 31) - at the level of R3-R4 (palmar and axillary hyperhidrosis), the third group (n = 22) - at the level of R2 (blushing syndrome).

Results. In this study, coagulation and separation of the sympathetic trunk through a single port using a silicone port was performed. An excellent clinical result was achieved due to the minimally invasive operation - all 62 patients (100%) were satisfied with the achievement of a rapid stable effect. According to the results of the Dermatology Life Quality Index DLQI (1 month after surgery), the best quality of life measures were observed in patients who underwent separation of the sympathetic trunk at the R3 level – improvement from 20.3 ± 5.9 points to 0.8 ± 0.8 points. After the operation at the R3-R4 level scores the quality of life decreased from 22.77 ± 5.4 points to 2.3 ± 1.3 points, and at the level of R2 - from 16.5 points (QI 14 points - QIII 20 points) to 2 points (QI 1 point - QIII 3 points) p <0.001).

There was a difference in quality of life measures in our three groups of patients according to the severity of the disease before surgery. The lowest quality of life was determined in patients with the 4th degree of severity (33 people) and was 26.0 points (QI 23.0 points - QIII 27.3 points) compared with patients with 2d and 3d degrees of severity, 10.0 points (QI 7.7 points - QIII 10.0 points) and 17.0 points (QI 14.0 points - QIII 19.5 points) respectively (p <0.001). After a single-port VATS in three groups there was an increase in quality of life measure, regardless of the severity of the disease before surgery.

Conclusions. The most highly specific tests that allow to determine an objective assessment of the severity of the disease and a real assessment of the effectiveness of surgical treatment for hyperhidrosis was TEWL-metry, for blushing syndrome – capillaroscopy.

VATS is an effective method of treating patients with hyperhidrosis and blushing syndrome, which significantly improves the quality of life according to the results of the Dermatological Index of Life Quality DLQI (p <0.001) questionnaire.

Author Biographies

Oleksii A. Eroshkin, Central Hospital of the Ministry of Internal Affairs of Ukraine (Central Police Hospital), Kyiv, Ukraine; Medical Center “MedСlinic”, Kyiv, Ukraine

Department of Neurosurgery

Vitaliy V. Sokolov, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine

Department of Thoracic Surgery and Pulmonology

Anastasiia V. Omelchenko, Medical Center “MedСlinic”, Kyiv, Ukraine; Bogomolets National Medical University, Kyiv, Ukraine

Department of General Surgery No 2

Dmytro M. Romanukha, Central Hospital of the Ministry of Internal Affairs of Ukraine (Central Police Hospital), Kyiv, Ukraine

Department of Neurosurgery

References

1. Caviezel C, Schuepbach R, Grande B, Opitz I, Zalunardo M, Weder W, Hillinger S. Establishing a non-intubated thoracoscopic surgery programme for bilateral uniportal sympathectomy. Swiss Med Wkly. 2019 Apr 17;149:w20064. [CrossRef] [PubMed]

2. Migliore M, Palazzolo M, Pennisi M, Nardini M, Borrata F. Extended uniportal bilateral sympathectomy. J Vis Surg. 2018 Jan 30;4:27. [CrossRef] [PubMed] [PubMed Central]

3. Baumgartner FJ, Bertin S, Konecny J. Superiority of thoracoscopic sympathectomy over medical management for the palmoplantar subset of severe hyperhidrosis. Ann Vasc Surg. 2009 Jan-Feb;23(1):1-7. [CrossRef] [PubMed]

4. Weng W, Liu Y, Li J, Jiang G, Liu J, Wang J. A long-term evaluation of postoperative moist hands after R4/R4+5 sympathectomy for primary palmar hyperhidrosis. J Thorac Dis. 2018 Mar;10(3):1532-1537. [CrossRef] [PubMed] [PubMed Central]

5. Cerfolio RJ, De Campos JR, Bryant AS, Connery CP, Miller DL, DeCamp MM, McKenna RJ, Krasna MJ. The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg. 2011 May;91(5):1642-8. [CrossRef] [PubMed]

6. Hajjar WM, Al-Nassar SA, Al-Sharif HM, Al-Olayet DM, Al-Otiebi WS, Al-Huqayl AA, Hajjar AW. The quality of life and satisfaction rate of patients with upper limb hyperhidrosis before and after bilateral endoscopic thoracic sympathectomy. Saudi J Anaesth. 2019 Jan-Mar;13(1):16-22. [CrossRef] [PubMed] [PubMed Central]

7. Ishy A, de Campos JR, Wolosker N, Kauffman P, Tedde ML, Chiavoni CR, Jatene FB. Objective evaluation of patients with palmar hyperhidrosis submitted to two levels of sympathectomy: T3 and T4. Interact Cardiovasc Thorac Surg. 2011 Apr;12(4):545-8. [CrossRef] [PubMed]

8. Hughes J. Endothoracic Sympathectomy. Proc R Soc Med. 1942 Jul;35(9):585-6. [PubMed] [PubMed Central]

9. Eroshkin OA, Sokolov VV, Romanukha DM, Omelchenko AV, Voytsekhovskyy SS.[ Device for monoportal video-assisted thoracoscopic sympathectomy]. Application for a patent of Ukraine u 2020 08213 dated 12/21/2020. A positive decision was received on 03/19/2021. Ukrainian.

10. Basra MK, Fenech R, Gatt RM, Salek MS, Finlay AY. The Dermatology Life Quality Index 1994-2007: a comprehensive review of validation data and clinical results. Br J Dermatol. 2008 Nov;159(5):997-1035. [CrossRef] [PubMed]

11. Kowalski JW, Eadie N, Dagget S, Lai P-Y. Validity and reliability of the hyperhidrosis disease severity scale (HDSS). Journal of the American Academy of Dermatology. 2004 Mar;50(3):P51. [CrossRef]

12. Tetteh HA, Groth SS, Kast T, Whitson BA, Radosevich DM, Klopp AC, D'Cunha J, Maddaus MA, Andrade RS. Primary palmoplantar hyperhidrosis and thoracoscopic sympathectomy: a new objective assessment method. Ann Thorac Surg. 2009 Jan;87(1):267-74; discussion 274-5. [CrossRef] [PubMed]

13. Miotto A, Honda PAA, Bachichi TG, Holanda CS, Evangelista Neto E, Perfeito JAJ, Leão LEV, Costa ADS Jr. Comparative study of transepidermal water loss in patients with and without hyperhidrosis by closed-chamber measurer in an air-conditioned environment. Einstein (Sao Paulo). 2018 Nov 8;16(4):eAO4312. [CrossRef] [PubMed] [PubMed Central]

14. Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2013 Mar;48(3):452-8. [CrossRef] [PubMed] [PubMed Central]

15. Du X, Zhu X, Wang T, Hu X, Lin P, Teng Y, Fan C, Li J, Xi Y, Xiao J, Liu W, Zhang J, Zhou H, Tian D, Yuan S. Compensatory hyperhidrosis after different surgeries at the same sympathetic levels: a meta-analysis. Ann Transl Med. 2018 Jun;6(11):203. [CrossRef] [PubMed] [PubMed Central]

16. Sternbach JM, DeCamp MM. Targeting the Sympathetic Chain for Primary Hyperhidrosis: An Evidence-Based Review. Thorac Surg Clin. 2016 Nov;26(4):407-420. [CrossRef] [PubMed]

17. de Paula Loureiro M, de Campos JR, Wolosker N, Kauffman P, editors. Hyperhidrosis: A Complete Guide to Diagnosis and Management. Springer; 2018. [CrossRef]

18. Jeganathan R, Jordan S, Jones M, Grant S, Diamond O, McManus K, Graham A, McGuigan J. Bilateral thoracoscopic sympathectomy: results and long-term follow-up. Interact Cardiovasc Thorac Surg. 2008 Feb;7(1):67-70. [CrossRef] [PubMed]

19. Heidemann E, Licht PB. A comparative study of thoracoscopic sympathicotomy versus local surgical treatment for axillary hyperhidrosis. Ann Thorac Surg. 2013 Jan;95(1):264-8. [CrossRef] [PubMed]

20. Aoki H, Sakai T, Murata H, Sumikawa K. Extent of sympathectomy affects postoperative compensatory sweating and satisfaction in patients with palmar hyperhidrosis. J Anesth. 2014 Apr;28(2):210-3. [CrossRef] [PubMed]

21. Cohen JL, Cohen G, Solish N, Murray CA. Diagnosis, impact, and management of focal hyperhidrosis: treatment review including botulinum toxin therapy. Facial Plast Surg Clin North Am. 2007 Feb;15(1):17-30, v-vi. [CrossRef] [PubMed]

22. Nawrocki S. Diagnosis and qualitative identification of hyperhidrosis. AME Publishing Company; 2019 Jul;3:35–35. [CrossRef]

Published

2021-06-27

How to Cite

Eroshkin, O. A., Sokolov, V. V., Omelchenko, A. V., Luzhenetska, I. R., & Romanukha, D. M. (2021). Treatment outcomes and objectification methods of the thoracoscopic sympathectomy in patients with focal hyperhidrosis and blushing syndrome. Ukrainian Neurosurgical Journal, 27(2), 41–48. https://doi.org/10.25305/unj.227762

Issue

Section

Original articles