T3 Versus T4 Sympathicotomy for Treatment of Primary Palmar Hyperhidrosis
Condition: Compensatory Hyperhidrosis; Recurrence
MeSH terms: Hyperhidrosis; Recurrence
Study type: Interventional

Summary: 
      T3 versus T4 as a primary treatment for palmer hyperhydrosis and effect on postoperative
      compensatory hyperhydrosis
    

Detailed description: 
      Palmar hyperhidrosis (PH) is a benign sympathetic disorder that does not threaten health but
      affects daily activities, and may causes social withdrawal and even depression.1 An incidence
      of up to 1% has been reported by various series in the literature. The incidence in men and
      women is the same; however women are more likely to seek medical attention, which may explain
      the higher incidence of female patients in most surgical series [2,3]. Although various
      treatment options are available, including topical and systemic therapies, iontophoresis,
      regional nerve block, and botulinum toxin injection, each has its limitations 4.
      Video-assisted thoracoscopic sympathetic surgery is currently a worldwide accepted treatment
      of primary palmar hyperhidrosis (PH) 5. However, compensatory hyperhidrosis (CH) is the most
      common and serious side effect that occurs in 30-70% of patients after T2 or T2-3
      sympathectomy 6. For that now T2 sympathetic surgeries are seldom used in PH. Procedures that
      involve T3 or/and T4 sympathetic ganglions are widely accepted in many centers with
      favourable results.5 But some patients still present with certain degrees of CH or over dry
      hands after operation 7, 8.

      The aim of this study is to compare the two methods for the treatment of PH, in which the
      sympathetic chain was transected in merely one segment, on the level of either the third or
      the fourth ribbed, defined as T3 sympathicotomy or T4 sympathicotomy, respectively. Emphasis
      was placed on the evaluation of the efficacy, side effects, and patients' satisfaction rate
      to these two types of surgical therapy.
    

Intervention name(s): t3 sympathicotomy; t4 symapthicotomy
Intervention type(s): Procedure; Procedure
Intervention description(s): The sympathetic chain was identified at the level of the crossing of the third or fourth costal heads after dissection of the parietal pleura and completely divided about 1 cm wide at the upper margin of the rib. With assistance of anaesthesia team we reinflate the lung totally in sequence with removal of the trocars. The same procedure was performed on the opposite side and ablation of the sympathetic chain overlying the rib was performed bilaterally. At the end of surgery, a postoperative chest x-ray was routinely taken to rule out pneumothorax or hemothorax.; The sympathetic chain was identified at the level of the crossing of the third or fourth costal heads after dissection of the parietal pleura and completely divided about 1 cm wide at the upper margin of the rib. With assistance of anaesthesia team we reinflate the lung totally in sequence with removal of the trocars. The same procedure was performed on the opposite side and ablation of the sympathetic chain overlying the rib was performed bilaterally. At the end of surgery, a postoperative chest x-ray was routinely taken to rule out pneumothorax or hemothorax.
Other intervention name(s): sympathectomy; sympathectomy
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment