scholarly journals The Effect of T3 versus T4 Thoracoscopic Sympathectomy on Hyperhidrosis

2021 ◽  
pp. 101-110
Author(s):  
Karim Mohamed El Mesery ◽  
Ahmed Emadeldeen Ghoneim ◽  
Abd Elhady Mohamed Taha ◽  
Mohamed Mahmoud Abo Elnasr
Keyword(s):  
Postoperative Complications ◽  
Treatment Success ◽  
Palmar Hyperhidrosis ◽  
Surgical Approaches ◽  
Compensatory Hyperhidrosis ◽  
Thoracoscopic Sympathectomy ◽  
Video Assisted ◽  
Significant Difference ◽  
Primary Hyperhidrosis

Background: Primary hyperhidrosis is a disorder characterized by excessive sweating. However, surgical therapy is the most effective treatment for patients with primary hyperhidrosis. In between all different surgical approaches, video assisted thoracoscopic surgery (VATS) sympathectomy has been considered as a safe and minimally invasive procedure for palmer and axillary hyperhidrosis. The aim of this study was to evaluate the effectiveness of T3 vs. T4 sympathectomy regarding postoperative complications, recurrence and compensatory hyperhidrosis (CH) on 6 months follow up. Methods: This prospective randomized study was conducted over 20 patients undergoing VATS sympathectomy diagnosed with palmar hyperhidrosis and failed medical treatment and undergoing thoracoscopic sympathectomy. Patients were divided randomly into two groups; group A (T3 sympathectomy) and group B (T4 sympathectomy). Results: There was no significant difference between the two groups regarding the degree of treatment success, compensatory hyperhidrosis after one month and after 6 months. There was non-significant difference between the two groups regarding the recurrence, late postoperative complications and satisfaction. Conclusions: Video-assisted T3 or T4 sympathectomy is a safe and effective procedure for treatment of palmar hyperhidrosis and T3 or T4 sympathectomy had no difference regarding to dryness and Compensatory Hyperhidrosis in follow-up for 6 months. Both techniques were effective for treating palmar hyperhidrosis with high rates of success and no recurrence for 6 months.

Plantar hyperhidrosis associated with primary palmar hyperhidrosis: Outcome following video-assisted thoracoscopic sympathectomy

2021 ◽  
pp. 021849232199650
Author(s):  
Walid Salah Abu Arab ◽  
Moustafa Mohamed Elhamami
Keyword(s):  
Visual Analogue Scale ◽  
Scale Score ◽  
Visual Analogue Scale Score ◽  
Analogue Scale ◽  
Palmar Hyperhidrosis ◽  
Compensatory Sweating ◽  
Compensatory Hyperhidrosis ◽  
Thoracoscopic Sympathectomy ◽  
Video Assisted ◽  
Surgery Department

Introduction Primary palmar hyperhidrosis is an abnormal over-sweating of palms. It is usually associated with plantar hyperhidrosis. Video-assisted thoracoscopic sympathectomy is the treatment of choice for palmar hyperhidrosis; however, it may affect plantar hyperhidrosis. Objectives The aim of this study was to evaluate the effect of thoracoscopic sympathectomy on plantar hyperhidrosis. Methods This prospective study included patients who presented to the Cardiothoracic Surgery Department with primary palmo-planter hyperhidrosis and received thoracoscopic sympathectomy between January 2014 and December 2018. Preoperatively, patients scored subjectively the degree of palmar and plantar hyperhidrosis on Visual Analogue Scale. Following surgery, scoring was performed at three intervals: 7, 30, and 180 days. Presence of compensatory sweating and its scoring was obtained at the same intervals. Complications and patient satisfaction were recorded. Results A total of 518 patients were included. Complication rate, excluding compensatory hyperhidrosis, was 2.7%. Preoperative Visual Analogue Scale score for palmar hyperhidrosis was 9.9 ± 3.8 that following thoracoscopic sympathectomy decreased to 0.041 ± 0.2 on the seventh postoperative day. Further decrease to 0.3 ± 0.16 was noted on the 30th day and 180th day postoperatively. Preoperative Visual Analogue Scale score for plantar hyperhidrosis was 9.54 ± 0.66 that following sympathectomy decreased to 2.27 ± 1.67 on the seventh postoperative day. However, slight insignificant increase was noted to become 2.73 ± 1.65 on the 30th day and 6th month postoperatively. Compensatory hyperhidrosis was recorded in 3.9% of patients at 6th month postoperatively. Conclusion Palmar hyperhidrosis is usually associated with plantar hyperhidrosis. Thoracoscopic sympathectomy is an effective and safe treatment for palmar hyperhidrosis. It may completely or partially cure plantar hyperhidrosis.

scholarly journals Uniportal video-assisted thoracoscopic drainless sympathectomy for palmar and palmo-plantar hyperhidrosis: an institutional experience

2020 ◽  
Vol 28 (1) ◽  
Author(s):  
Mohammed Ahmed El-Hag-Aly ◽  
Rafik Fekry Soliman ◽  
Nehad Abdo Zaid ◽  
Mahmoud Said Eldesouky ◽  
Mohamed Mordy Bakoush ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Operative Time ◽  
Compensatory Hyperhidrosis ◽  
Thoracic Sympathectomy ◽  
Significant Difference ◽  
Institutional Experience ◽  
Primary Hyperhidrosis ◽  
Disease Severity Scale

Abstract Background Primary hyperhidrosis (PH) still impacts negatively the patient’s quality of life (QoL). Progressively, it leads to poorer QoL regardless of gender. The endoscopic thoracic sympathectomy has been used safely and effectively for control of palmar hyperhidrosis, but it is still questionable in palmo-plantar type. We assessed the benefits of uniportal drainless thoracoscopic sympathectomy (UDTS) for palmo-plantar hyperhidrosis patients compared to palmar ones. This prospective study comprised 213 consecutive patients with PH. They underwent bilateral simultaneous UDTS. We used the Hyperhidrosis Disease Severity Scale (HDSS) scoring system for assessment of QoL pre- and postoperatively. Follow-up was continued for 1-year that was aiming to detect the QoL improvement, recurrence, and compensatory hyperhidrosis (CH). Results All patients experienced immediate complete resolution of hyperhidrosis postoperatively. Recurrence was encountered in one patient during the first 6 months. All patients had improved QoL postoperatively, but at the end of 1-year follow-up, 2.8% of patients were still suffering moderate to severe impaired QoL. Mean hospital stay was 31.79 ± 17.5 h. We found significant longer hospital stay in palmar group than palmo-plantar group. There was no significant difference between both groups in neither operative time, recurrence, nor CH. Conclusions UDTS offers better QoL for patients with PH even the palmo-plantar type. The palmo-plantar type benefits similarly to the palmar type in terms of comparable postoperative QoL and CH incidence.

scholarly journals The Rate of Compensatory Sweating and Clinical Outcomes of Selective Thoracoscopic Sympathectomy (Ramicotomy) in Patients with Primary Palmar Hyperhidrosis

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Karamollah Toolabi ◽  
Siavash Khaki ◽  
Ehsan Sadeghian ◽  
Narges Lamsehchi ◽  
Fezzeh Elyasinia
Keyword(s):  
Clinical Outcomes ◽  
Palmar Hyperhidrosis ◽  
Compensatory Sweating ◽  
Thoracoscopic Sympathectomy ◽  
Lower Back ◽  
Term Adverse Effect ◽  
Significant Difference ◽  
Primary Hyperhidrosis ◽  
High Level

Background: Primary hyperhidrosis is a sympathetic disorder characterized by prolonged and uncontrollable sweating. It is associated with emotional stress or psychological causes that preferably affects the axillae, palms, feet, and face. Video-assisted thoracoscopic sympathetic surgery is currently a globally recognized treatment for primary palmar hyperhidrosis (PH). However, compensatory sweating (CS) is the most prominent long-term adverse effect of thoracoscopic sympathectomy. Objectives: Here, we aim to perform selective sympathetic ramicotomy for primary palmar hyperhidrosis patients and evaluate the clinical outcomes of satisfaction, as well as the effect on the frequency, location, and severity of compensatory sweating. Methods: In this single-arm trial study, 24 sympathectomies were carried out on 12 patients with primary palmar hyperhidrosis who were candidates for bilateral thoracoscopic selective sympathectomy (ramicotomy) at Imam Khomeini Hospital. The patients’ demographic information was interviewed and followed up using telephone questionnaires in the health center one week after surgery. Then, the rates of compensatory sweating, satisfaction, and failure or recurrence were retrospectively analyzed. Results: No significant differences were observed between age, gender, weight, BMI, and compensatory sweating rates. Notwithstanding, there was a statistically significant difference in the severity of compensatory sweating with patients’ height (P = 0.016). Compensatory sweating occurred in 66.7% of the patients; 50% of the patients were mild, 16.7% of the patients were moderate, and there was no intolerable compensatory sweating or recurrence. The most incidence of compensatory sweating was on the lower back. The rate of satisfaction was 94.5 ± 7.8%. Conclusions: Selective thoracoscopic sympathectomy (ramicotomy) is an effective surgical procedure with a very high level of precision and satisfaction. This technique hence should be considered the method of choice for the treatment of primary palmar hyperhidrosis.

scholarly journals The Influence of Body Mass Index on the Outcomes of Video-assisted Thoracoscopic Sympathectomy for Primary Hyperhidrosis Patients

2019 ◽  
Vol 4 (3) ◽  
pp. p228
Author(s):  
Mohamad Mahseeri ◽  
Isam Bsisu ◽  
Yousef AL-Bustanji ◽  
Ahmad Suleihat ◽  
Rami Ayoub ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
University Hospital ◽  
Excessive Sweating ◽  
Compensatory Hyperhidrosis ◽  
Thoracoscopic Sympathectomy ◽  
Patient’S Satisfaction ◽  
Video Assisted ◽  
Desirable Outcome ◽  
Primary Hyperhidrosis

Background: Primary hyperhidrosis (PH) is an autonomic disorder described as having excessive sweating in greater amounts than physiologically needed for thermoregulation. The aim of this retrospective study is to investigate the effect of body mass index (BMI) on surgical outcomes of bilateral video-assisted thoracoscopic sympathectomy (VATS) for PH patients from Arabian ethnic group. Methods: Between January 2009 and December 2018, a total of 79 patients underwent VATS as a treatment for PH at Jordan University Hospital. Postoperative assessment was done via patients’ subjective reporting of their satisfaction with the outcome of performed procedure. Results: The mean age of the studied population was 23.2 ± 4.5 years, of which 34 (43%) were males and 45 (57%) were females. Satisfaction with the outcome of VATS was significantly associated with having dry palms as a desirable outcome (p < 0.001), and with older age (p = 0.002). BMI was neither significantly associated with their satisfaction (p = 0.128), nor with compensatory hyperhidrosis (CH) (p= 0.859).Conclusion: VATS is considered an effective treatment for PH, with high rates of patient’s satisfaction. Neither the level of satisfaction nor the occurrence of CH was associated with patients’ BMI.

Total Knee Arthroplasty Is Safe in Jehovah's Witness Patients—A 12-Year Perspective

2019 ◽  
Vol 33 (01) ◽  
pp. 034-041 ◽  
Author(s):  
Theodore S. Wolfson ◽  
David Novikov ◽  
Kevin K. Chen ◽  
Kelvin Y. Kim ◽  
Afshin A. Anoushiravani ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Complications ◽  
Knee Arthroplasty ◽  
Subgroup Analysis ◽  
Blood Management ◽  
Folate Supplementation ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Total Knee

AbstractDespite the evolution of blood management protocols, total knee arthroplasty (TKA) occasionally requires allogeneic blood transfusion. This poses a particular challenge for Jehovah's Witnesses (JW) who believe that the Bible strictly prohibits the use of blood products. The aim of this study was to compare JW and a matched-control cohort of non-JW candidates undergoing TKA to assess the safety using modern blood management protocols. Fifty-five JW patients (63 knees) who underwent TKA at our institution between 2005 and 2017 were matched to 63 non-JW patients (63 knees). Patient demographics, intraoperative details, and postoperative complications including in-hospital complications, revisions, and 90-day readmissions were collected and compared between the groups. Additionally, subgroup analysis was performed comparing JW patients who were administered tranexamic acid (TXA) between the two groups. Baseline demographics did not vary significantly between the study cohorts. The mean follow-up was 3.1 years in both the JW and non-JW cohorts. Postoperative complications, including in-hospital complications (7.9 vs. 4.8%; p = 0.47), revision TKA (1.6 vs. 1.6%; p = 1.00), and 90-day readmission (1.6 vs. 4.8%; p = 0.31) were not significantly different between the JW and non-JW groups. Subgroup analysis demonstrated JW patients who received TXA had a significantly lower decline in postoperative hemoglobin (Hgb) (8.6 vs. 14.0%; p < 0.01). At a follow-up of up to 12 years, JW patients who underwent TKA have outcomes equivalent to non-JW patients without the need for transfusion. Our findings support that surgeons are more likely to optimize JW patients preoperatively with iron and folate supplementation. Despite these variations in preoperative optimization efforts, no significant difference with regard to Hgb or hematocrit levels was demonstrated. Level of evidence is III, retrospective observational study.

scholarly journals Analysis of Approaches in the Microsurgical Treatment of 102 Cases of Petroclival Meningioma in a Single Center

2021 ◽  
Vol 12 ◽  
Author(s):  
Yazhou Lin ◽  
Qiang Gao ◽  
Huiping Jin ◽  
Nana Wang ◽  
Dingkang Xu ◽  
...  
Keyword(s):  
Attachment Site ◽  
Petrous Apex ◽  
Surgical Approaches ◽  
Karnofsky Performance Scale ◽  
Therapeutic Effects ◽  
Single Center ◽  
Petroclival Meningioma ◽  
Tumor Subtypes ◽  
Significant Difference

Objectives: We identified the optimal approaches for treating the diverse tumor subtypes of petroclival meningioma (PM) by analyzing the clinical benefits of various surgical approaches adopted for each subtype.Methods: Tumors in 102 PM patients from a single center who underwent surgical treatment were classified as upper clivus (UC), cavernous sinus (CS), tentorium (TE), or petrous apex (PA) types based on the attachment site of the tumor base and the displacement of the trigeminal nerve. The therapeutic effects of different surgical approaches among the subtypes were evaluated according to the patient outcomes.Results: The subtemporal (33.33%), retrosigmoid (16.67%), and Kawase approaches (50%) were used for the UC type. Simpson I/II resection was achieved in 46.66% of patients with the Kawase approach. Significant differences were found between the other two approaches (P = 0.044) and in the follow-up Karnofsky performance scale (KPS) scores (P = 0.008). The subtemporal (60%) and Kawase approaches (40%) were used for the CS type; neither approach achieved Simpson I/II resection. The retrosigmoid (25.81%) and Kawase approaches (74.19%) were used for the TE type. The Simpson I/II resection rates of the two approaches were 55.55 and 86.95%, respectively, and a significant difference was observed between them (P = 0.039). The retrosigmoid (43.75%) and Kawase approaches (56.25%) were used for the PA type. The Simpson I/II resection rates of the two approaches were 31.25 and 50%, respectively. The resection degrees of the two approaches and the KPS scores at follow-up were significantly different (P = 0.034).Conclusion: The individual microsurgical approaches adopted for the various PM tumor subtypes can provide maximal safe resection and good KPS scores. The Kawase approach is more suitable for PM, especially for UC- and PA-type PM tumors.

Comparison Between Supraclavicular Versus Video-Assisted Intrathoracic Phrenic Nerve Section for Transfer in Patients With Traumatic Brachial Plexus Injuries: Case Series

2020 ◽  
Vol 19 (3) ◽  
pp. 249-254
Author(s):  
Mariano Socolovsky ◽  
Marcio de Mendonça Cardoso ◽  
Ana Lovaglio ◽  
Gilda di Masi ◽  
Gonzalo Bonilla ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Case Series ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Nerve Section ◽  
Video Assisted ◽  
Significant Difference ◽  
Flexion Strength

Abstract BACKGROUND The phrenic nerve has been extensively reported to be a very powerful source of transferable axons in brachial plexus injuries. The most used technique used is supraclavicular sectioning of this nerve. More recently, video-assisted thoracoscopic techniques have been reported as a good alternative, since harvesting a longer phrenic nerve avoids the need of an interposed graft. OBJECTIVE To compare grafting vs phrenic nerve transfer via thoracoscopy with respect to mean elbow strength at final follow-up. METHODS A retrospective analysis was conducted among patients who underwent phrenic nerve transfer for elbow flexion at 2 centers from 2008 to 2017. All data analysis was performed in order to determine statistical significance among the analyzed variables. RESULTS A total of 32 patients underwent supraclavicular phrenic nerve transfer, while 28 underwent phrenic nerve transfer via video-assisted thoracoscopy. Demographic characteristics were similar in both groups. A statistically significant difference in elbow flexion strength recovery was observed, favoring the supraclavicular phrenic nerve section group against the intrathoracic group (P = .036). A moderate though nonsignificant difference was observed favoring the same group in mean elbow flexion strength. Also, statistical differences included patient age (P = .01) and earlier time from trauma to surgery (P = .069). CONCLUSION Comparing supraclavicular sectioning of the nerve vs video-assisted, intrathoracic nerve sectioning to restore elbow flexion showed that the former yielded statistically better results than the latter, in terms of the percentage of patients who achieve at least level 3 MRC strength at final follow-up. Furthermore, larger scale prospective studies assessing the long-term effects of phrenic nerve transfers remain necessary.

scholarly journals T3 versus T4 video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis

Medicine ◽  
2019 ◽  
Vol 98 (42) ◽  
pp. e17272
Author(s):  
Sui Chen ◽  
Peipei Zhang ◽  
Tianci Chai ◽  
Zhimin Shen ◽  
Mingqiang Kang ◽  
...  
Keyword(s):  
Palmar Hyperhidrosis ◽  
Thoracoscopic Sympathectomy ◽  
Video Assisted

P12 LONG-TERM QUALITY OF LIFE AFTER TOTAL GASTRECTOMY VERSUS IVOR LEWIS ESOPHAGECTOMY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
E Jezerskyte ◽  
L M Saadeh ◽  
E R C Hagens ◽  
M A G Sprangers ◽  
L Noteboom ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Postoperative Complications ◽  
Total Gastrectomy ◽  
Nausea And Vomiting ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Significant Difference

Abstract Aim The aim of this study was to investigate the difference in long-term health-related quality of life in patients undergoing total gastrectomy versus Ivor Lewis esophagectomy in a tertiary referral center. Background & Methods Surgical treatment for gastroesophageal junction (GEJ) cancers is challenging. Both a total gastrectomy and an esophagectomy can be performed. Which of the two should be preferred is unknown given the scarce evidence regarding effects on surgical morbidity, pathology, long-term survival and health-related quality of life (HR-QoL). From 2014 to 2018, patients with a follow-up of > 1 year after either a total gastrectomy or an Ivor Lewis esophagectomy for GEJ or cardia carcinoma completed the EORTC QLQ-C30 and EORTC QLQ-OG25 questionnaires. Problems with eating, reflux and nausea and vomiting were chosen as the primary HR-QoL endpoints. The secondary endpoints were the remaining HR-QoL domains, postoperative complications and pathology results. Multivariable linear regression was applied taking confounders age, gender, ASA classification and neoadjuvant therapy into account. Results 30 patients after gastrectomy and 71 after Ivor Lewis esophagectomy with a mean age of 63 years were included. Median follow-up was two years (range 12-84 months). Patients after total gastrectomy reported significantly less choking when swallowing and coughing (β=-5.952, 95% CI -9.437 – -2.466; β=-13.084, 95% CI -18.525 – -7.643). Problems with eating, reflux and nausea and vomiting were not significantly different between the two groups. No significant difference was found in postoperative complications or Clavien-Dindo grade. Significantly more lymph nodes were resected in esophagectomy group (p=0.008). No difference in number of positive lymph nodes or R0 resection was found. Conclusion After a follow-up of > 1 year choking when swallowing and coughing were less common after total gastrectomy. No significant difference was found in problems with eating, reflux or nausea and vomiting nor in postoperative complications or radicality of surgery. Based on this study no general preference can be given to either of the procedures for GEJ cancer. Patients may be informed about the HR-QoL domains that are likely to be affected by the different surgical procedures, which in turn may support shared decision making when a choice between the two treatment options is possible.

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