Videothoracoscopic sympathectomy - a standard treatment for primary hyperhidrosis at the Clinic of Thoracic Surgery in Sremska Kamenica / Videotorakoskopska simpatektomija – standarna hirurška metoda za lečenje primarne hiperhidroze na Klinici za grudnu hirurgiju u Sremskoj Kamenici

Primary hyperhidrosis affects approximately 3% of the world’s population, particularly young female adults. It is defined as excessive, profuse sweating of the palms, soles, armpits and face. Conservative treament includes diverse modalities, however, surgical treatment has shown the best long-term results. The objective of this study was to assess some disease-specific epidemiological characteristics in a pre-selected group of patients seeking surgical therapy, as well as outcomes of thoracoscopic sympathectomy. The severity and impact of hypehidrosis was assessed, using Hyperhidrosis Disease Severity Scale (HDSS: patients rate the serverity of symptoms on a scale from 1 to 4). Thoracoscopic sympathectomy was performed using a double lumen endotracheal tube, via bilateral 5 mm dual port videothoracoscopic camera 0°, and an endoscopic ultrasound activated harmonic scalpel. The sympathetic chain was resected on both sides at the level of the second and the third thoracic ganglion (T2 and T3), using an ultrasound knife. The extirpated chain was also at the level T3-T4 and sent for ex tempore analysis. There were 162 patients undergoing thoracoscopic sympathectomy: 39.51% were males and 60.49% females; at presentation their mean age (± SD) was 30.5 (±8.3), range 16 - 58 years. Axillary hyperhidrosis occurs later than palmar-axillary-plantar (p<0.05). A total of 35.18% of the evaluated patients were able to name at least one member of their families who also suffered from hyperhidrosis. The most commonly affected area was palmar-axillary-plantar (30.25%). Fifty patients (30.86%) received conservative therapy before surgery. The most commonly used conservative therapy modalities included different kinds of ointments/tinctures (11.73%), botox (8.02%) and iontophoresis (2.47%). Prior to surgery, 91.36% of patients reported severe sweating (HDSS score 3 or 4). The highest mean score was given for a combination of facial-palmar-axillaryplantar hyperhidrosis (3.80±0.24). All surgeries were successfully performed, with no complications, or perioperative morbidity. The mean hospital stay was 1.28±0.68 days long. After surgery, 93.21% of patients reported mild or moderate hyperhidrosis (HDSS score 1 or 2). Compensatory sweating (lower part of the back, and abdomen) was reported by 34.57% of patients after the surgery. All patients had a 6-months long follow-up: a significant improvement in quality of life was reported by 84.56% of patients (Yates corrected c2 (1) = 228.42; p=0.0000)); due to compensatory sweating, only 4.94% and 1.85% of patients reported bad and very bad quality of life, respectively.

In conclusion, nowadays videothoracoscopic sympathectomy is a standard treatment for primary hyperhidrosis with a high success rate.