Ramicotomy in association with endoscopic sympathetic blockade in the treatment of axillary hyperhidrosis

Ramicotomy in association with endoscopic sympathetic blockade in the treatment of axillary hyperhidrosis

The use of endoscopic sympathetic blockade (ESB) to treat axillary hyperhidrosis (AH) has become more widespread recently. ESB of the T3 and T4 ganglia is more effective, although it results in a higher incidence of compensatory sweating (CS) than ESB of T4 alone. To reduce CS and improve the level...

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Published in:Surgical laparoscopy, endoscopy & percutaneous techniques Vol. 23; no. 2; pp. 223 - 228
Main Authors: Guimarães, Paulo S F, Coelho, Marlos de Souza, Mendes, Rafael G, da Silva, Ruy F K Caetano, Fernandes, Lucas M, Cecilio, William A C
Format: Journal Article
Language:English
Published: United States 01-04-2013
Subjects:
Adolescent
Adult
Autonomic Nerve Block - methods
Axilla
Endoscopy - methods
Female
Follow-Up Studies
Humans
Hyperhidrosis - diagnosis
Hyperhidrosis - surgery
Male
Middle Aged
Patient Satisfaction - statistics & numerical data
Prospective Studies
Quality of Life
Risk Assessment
Severity of Illness Index
Sympathectomy - methods
Thoracic Vertebrae
Treatment Outcome
Young Adult
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Summary:The use of endoscopic sympathetic blockade (ESB) to treat axillary hyperhidrosis (AH) has become more widespread recently. ESB of the T3 and T4 ganglia is more effective, although it results in a higher incidence of compensatory sweating (CS) than ESB of T4 alone. To reduce CS and improve the level of satisfaction and therapeutic success of ESB, we performed T3 ramicotomy in association with T4 ESB. Ninety patients with axillary hyperhidrosis were randomized into 3 groups of 30 patients-group A (T3 and T4 ESB), group B (T4 ESB), and group C (T4 ESB in association with T3 ramicotomy)--and evaluated for CS, therapeutic success and degree of satisfaction 7 days, 6 months, and 1 year after the procedure. CS was observed in 72 patients (80%) and classified as minor in 63 (70%), moderate in 7 (7.8%), and severe in 2 (2.2%). These results were not statistically significant. There was a higher proportion of remission of symptoms and therapeutic success in group B (100%, P=0.008). Forty-seven patients (52.2%) considered themselves very satisfied, 41 (43.3%) satisfied, and only 2 (2.2%) dissatisfied with their surgery. ESB of T4 alone was more effective than ESB of T3 and T4 together and ESB of T4 in association with T3 ramicotomy. No significant difference was found between the techniques in terms of patient satisfaction or the occurrence and degree of CS; however, in group C, CS was more intense in the thighs, whereas in group A it was more intense in other areas.
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ISSN:1530-4515
1534-4908
DOI:10.1097/SLE.0b013e31828a0aec