The comparison of VATS ramicotomy and VATS sympathicotomy for treating essential hyperhidrosis

Abstract

This study was undertaken to detemmne if better results could be achieved by comparing the results of a thoracic sympathetic ramicotomy (division of rami communicantes) with a conventional thoracic sympathicotomy (division of sympathetic ft* for treating essential hypethidrosis. From August 2001 to February 2002, 29 consecutive patients under-went surgery of the sympathetic nerves in order to treat severe essential hyperhidr+osis. Of these patients, a ramicotomy was performed under VATS (VATS-R) in 13 patients, sympathicotomy under VATS (VATS-S) in 13, a unilateral ramicotomy and cone alataal sympathicotomy under VATS (VATS-RS) in 2 and a sympathicotomy via a thoracotomy (T-S) in 1. There was no significant difference between the VATS ramicotomy group (VATS-R, n-13) and VATS sympathicotomy group (VATS-S, n=13) in tams of gender, pleural adhesions or cornorbidities. However, the age of the VATS -S group at surgery was higher than that of the VATS-R group (p-0.050). The operation times, andhospital. stays of the groups were 51.5 and 41.9 mimrtes, and 2.0 and 2.3 days, respectively. The recurrence rate of the operated sites ac-cording to the surgical methods (ramicotomy and sympathicommy regardless of VATS) was 21.4% (6/28) in the rarm- - y gip and 6.7% (2/30) in the sympathicotomy gip, but there was no statistical significance (p-0.101). This study compared the dryness of the enervated sites and the severity of compensatory sweating among the ramicotorny (n-11, excluded 2 re-operated cases from 13 VATS-R), sympathicotomy (n-14, VATS-S 13 and T-S 1) and the synchronous or metachronous ramicotomy/sympathicotomy groups (n-4, included 2 reoperated cases of VATS-R). The sympathicotomy group had an over-dryness of the enervated sites (dryness 1.4, from 1 to 3; Lover-dried, 2:humid, 3:persistent sweating) and complained of severe compensatory sweating (severity 3.5, from 1 to 4; Labsent, 2:mild, 3:embarrassing, 4:disabling). However, the patients whoutudeuwent a ramicotomy maintained some humidity of the enervated sites (dryness 2.0, p-0.012) and showed milder compensatory sweating (severity 2.7, p-0.056) than those in the sympathicotomy grouup. Furthermore, the dryness of the ramicotomy side was different from that of the sympathicotomy side in 3 out of 4 ramicotoeny / sympathicotomy (R+S) patients (the side of the tamicotomy was humid and that of the sympaducotomy was over-dried). The average dryness and the compensatory sweating at these sites were in the midst of the two groins (dryness and severity 1.6 and 3.0, respectively). A ramicotomy can prevent overAmxw of the enervated area and decrease the severity of compensatory sweating through the selective division of the rani cormmmicantes of the thoracic sympathetic ganglia Postoperatively, almost all ramicotomy padents . had no functional problems in daily life or in their occupational activity, because they could maintain hand humidity. Moreover, they showed no more than a mild degree of compensatory sweating and reported high long-term satin faction rites. Therefore, a sympathetic ramicotomy rather than a conventional sympathicotorny is recon mended as a more selective and physiologic modality for treating essential hyperhidrosis.