T3T4 Endoscopic Sympathetic Blockade Versus T3T4 Video Thoracoscopic Sympathectomy in the Treatment of Axillary Hyperhidrosis

• Published in: The Annals of thoracic surgery Vol. 88; no. 6; pp. 1780 - 1785
• Main Authors: de Souza Coelho, Marlos, MD, PhD, Silva, Ruy Fernando Kuenzer Caetano, MD, Mezzalira, Giovanni, MD, Bergonse Neto, Nelson, MD, de Souza Stori, Wilson, MD, dos Santos, Anna Flávia Ribeiro, MD, El Haje, Samir, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-12-2009; Elsevier
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Autonomic Nerve Block - methods; Axilla; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Dermatology; Endoscopy - methods; Female; Follow-Up Studies; Humans; Hyperhidrosis - surgery; Male; Medical sciences; Patient Satisfaction; Pneumology; Skin involvement in other diseases. Miscellaneous. General aspects; Surgery; Sympathectomy - methods; Thoracic Nerves - drug effects; Thoracic Nerves - surgery; Thoracic Surgery, Video-Assisted - methods; Treatment Outcome; Young Adult; 13; Skin disease; Hyperhidrosis; Treatment; Sympathectomy; Anesthesia; Circulatory system; Endoscopy; Cardiology; Comparative study; Sweat gland disease; Axillary
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2009.08.007

Background The use of endoscopic sympathetic blockade (ESB) in the treatment of axillary hyperhidrosis has grown because of its potential reversibility. But it is still not clear whether the rates of success, compensatory sweating, and satisfaction are better than those accomplished with video thoracoscopic sympathectomy (VTS). Methods Eighty-four patients were studied to compare the rates of success, satisfaction, and compensatory sweating in patients undergoing either ESB or VTS of the T3T4 ganglion after 2 years' follow-up. Results Thirty-five patients (83.3%) undergoing ESB and 39 patients (92.8%) undergoing VTS had remission of axillary hyperhidrosis ( p = 0.315). Improvement was seen in 7 patients (16.7%) in the ESB group and 1 patient (2.4%) in the VTS group. Two patients (4.8%) had bad results in the VTS group. Absence of or minor compensatory sweating was observed in 25 patients (59.5%) in the ESB group and 28 patients (66.7%) in the VTS group, and moderate compensatory sweating occurred in 13 patients (31.0%) in the ESB group and 10 patients (23.8%) in the VTS group. Severe compensatory sweating was observed in 4 patients (9.5%) in the ESB group versus 4 patients (9.5%) in the VTS group ( p = 0.905). In the ESB group, 28 patients (66.7%) were very satisfied, 11 patients (26.2%) were satisfied, and 3 patients (7.1%) were unsatisfied with treatment. In the VTS group, 35 patients (83.3%) were very satisfied, 6 patients (14.3%) were satisfied, and 1 patient (2.4%) was unsatisfied with VTS. Conclusions Endoscopic sympathetic blockade and VTS of T3T4 ganglion are efficient in axillary hyperhidrosis treatment. We found no differences regarding therapeutic success, satisfaction rate, and incidence, severity, and location of compensatory sweating.