Video-Assisted Sympathectomy for Essential Hyperhidrosis
Abstract:
Essential hyperhidrosis is characterized by overactivity of the sympathetic fibers
passing through the upper-dorsal ganglia (second and third thoracic ganglia [D2-D3]), and the
treatment of choice is video-assisted thoracoscopy sympathectomy. Alterations in cardiopulmonary
function after treatment have been reported.
Study objective: To evaluate cardiopulmonary function impairment after sympathectomy in
patients with essential hyperhidrosis.
Design and setting: Prospective controlled trial at a pulmonary function unit of a university
hospital.
Patients: Twenty patients (2 men and 18 women) with essential hyperhidrosis.
Measurements and results: Pulmonary function tests, including spirometry and thoracic gas
volume, bronchial challenge with methacholine, and maximal exercise, were performed before
and 3 months after D2-D3 sympathectomy. Video-assisted sympathectomy was performed using
a one-stage bilateral procedure with electrocoagulation of D2-D3 ganglia. Pulmonary function
values (spirometrics and volumes) were not statistically different in the two groups. The maximal
midexpiratory flow was the only variable that showed significant changes, from 101% (SD, 26%)
to 92% (SD, 27%) [p < 0.05]. Ten patients had positive bronchial challenge test results that
remained positive 3 months after surgery, and 2 patients whose challenge test results were
negative before surgery became positive after sympathectomy. Significant reductions in maximal
heart rate (HR) and oxygen and carbon dioxide uptakes were observed during the maximal
exercise test.
Conclusions: Video-assisted thoracoscopy is a safe treatment, and the observed modifications in
cardiopulmonary function only suggest a minimal small airway alterations in the presence of
positive bronchial hyperresponsiveness and mild sympathetic blockade in HR. The clinical
importance of these findings is not significant.