Dataset Information

Thoracoscopic sympathetic block to predict compensatory hyperhidrosis in primary hyperhidrosis.

ABSTRACT:

Background

Compensatory hyperhidrosis is the main cause of patients' dissatisfaction following sympathectomy for primary hyperhidrosis. Therefore, thoracoscopic sympathetic nerve block before sympathectomy can be used to predict compensatory hyperhidrosis after sympathectomy. The objective of this study is to review our recent experience with the nerve block procedure, describing efficacy, safety and validity.

Methods

We retrospectively reviewed the medical records of 107 patients who underwent thoracoscopic sympathetic nerve block with a local anesthetic for primary palmar and craniofacial hyperhidrosis using a 2-mm needlescope from March 2017 to November 2019. A week later, the patients were interviewed, and a decision made as to whether to proceed with sympathectomy. We analyzed the perioperative data of patients who underwent the predictive procedure either followed, or not followed, by sympathectomy.

Results

Primary hyperhidrosis was relieved in all patients by the predictive procedure without severe complications. Compensatory hyperhidrosis happened to 32 patients (29.9%). Seventy-eight patients (72.9%) decided to undergo sympathectomy (group A) and 29 patients (27.1%) refused the sympathectomy (group B). Group B tended to have higher average body mass index (24.5 versus 23.2 kg/m², P=0.082) and compensatory hyperhidrosis rate after predictive procedure (37.9% versus 26.9%, P=0.269) compared to group A. The compensatory hyperhidrosis rate after sympathectomy in group A was 76.9%. The effective duration of sympathetic block was significantly longer in group A than in group B (33.5 versus 13.9 hours, P=0.001). The predictive procedure had 94.4% specificity and 33.3% sensitivity for prediction of compensatory hyperhidrosis.

Conclusions

Thoracoscopic sympathetic block may be safe and feasible as a procedure for predicting compensatory hyperhidrosis after sympathectomy, and beneficially, it allows the patients to experience the effect of sympathectomy on primary hyperhidrosis and occurrence of compensatory hyperhidrosis. However, a longer effective duration of sympathetic block is needed to help patients to decide whether to proceed with the surgery.

SUBMITTER: Lee J

PROVIDER: S-EPMC8264690 | biostudies-literature | 2021 Jun

REPOSITORIES: biostudies-literature

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Publications

Thoracoscopic sympathetic block to predict compensatory hyperhidrosis in primary hyperhidrosis.

Lee June J Jeong Jin Yong JY Suh Jong Hui JH Park Chan Beom CB Kwoun Hana H Park Soo Seog SS

Journal of thoracic disease 20210601 6

<h4>Background</h4>Compensatory hyperhidrosis is the main cause of patients' dissatisfaction following sympathectomy for primary hyperhidrosis. Therefore, thoracoscopic sympathetic nerve block before sympathectomy can be used to predict compensatory hyperhidrosis after sympathectomy. The objective of this study is to review our recent experience with the nerve block procedure, describing efficacy, safety and validity.<h4>Methods</h4>We retrospectively reviewed the medical records of 107 patients ...[more]

PMID: 34277046

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Project description:BackgroundPrimary focal hyperhidrosis (PFH) is associated with autonomic nervous activity, and studies investigating this association in patients with PFH are very important. Heart rate variability (HRV) is a simple and noninvasive electrocardiographic test showing activity and balance in the autonomic nervous system, which consists of sympathetic and parasympathetic components. The aims of this study are to investigate associations between autonomic nervous activity and hyperhidrosis characteristics using HRV and to investigate the association between HRV findings and compensatory hyperhidrosis (CH) after sympathectomy.MethodsFrom March 2017 to March 2020, 105 subjects with PFH who underwent preoperative HRV tests and sympathectomy were analyzed. All subjects underwent bilateral thoracoscopic sympathectomy. T2 sympathectomy was conducted for craniofacial hyperhidrosis, and T3 sympathectomy was conducted for palmar hyperhidrosis. The following HRV parameters chosen to investigate the association between hyperhidrosis and autonomic nervous activity were measured by time and frequency domain spectral analysis: (I) time domain: standard deviation of normal-to-normal interval (SDNN) and square root of mean squared differences of successive normal-to-normal intervals (RMSSD), (II) frequency domain: total power (TP) of power spectral density, very low frequency (VLF), low frequency (LF), and high frequency (HF). HRV parameters were analyzed according to hyperhidrosis type (craniofacial vs. palmar type), sweat reduction, and CH after sympathectomy. In addition, the independent HRV parameters influencing CH after sympathectomy were investigated with multivariate analysis.ResultsCraniofacial hyperhidrosis was significantly more prevalent in the old age group (P<0.001). Sweat reduction after sympathectomy was significantly more prominent in palmar hyperhidrosis (P=0.037), and CH after sympathectomy was more prominent in craniofacial hyperhidrosis (P<0.001). Palmar type patients exhibited significantly larger SDNN, RMSSD, TP, LF, and HF than craniofacial type patients (all P<0.001). There were no significant differences in any HRV parameters according to sweat reduction after sympathectomy. Low-degree CH was associated with significantly larger SDNN, RMSSD, TP, LF, and HF than high-degree CH (P<0.001, P<0.001, P=0.002, P=0.001, and P<0.001, respectively). Multivariate analysis showed that HF and age group were associated with CH after sympathectomy (P=0.007 and P=0.010, respectively).ConclusionsThis study shows that HRV can provide useful insight into the pathophysiology of PFH and enhance preoperative risk stratification of CH. Large-scale, prospective studies are required to determine the predictive value of HRV in patients at risk for subsequent CH after sympathectomy.

Project description:BackgroundAlthough sympathectomy is highly effective for improving symptom, compensatory hyperhidrosis (CH) is a major issue. In this study, characteristics of primary hyperhidrosis were investigated in terms of the heart rate variability (HRV) parameters. Classification of hyperhidrosis type and prediction of CH after sympathicotomy were also determined using machine learning analysis.MethodsFrom March 2017 to December 2021, 128 subjects who underwent HRV tests before sympathicotomy were analyzed. T2 and T3 bilateral endoscopic sympathicotomy were routinely performed in patients with craniofacial and palmar hyperhidrosis, respectively. Data collected age, sex, body mass index (BMI), hyperhidrosis type, symptom improvement after sympathicotomy, the degrees of CH after sympathicotomy, and preoperative HRV findings. The independent risk factors associated with the degree of CH after sympathicotomy were investigated. Machine learning analysis was used to determine classification of hyperhidrosis type and prediction of the degree of CH.ResultsPreoperatively, patients with palmar hyperhidrosis presented with significantly larger standard deviation of normal-to-normal (SDNN), root mean square of successive differences (RMSSD), total power (TP), and low frequency (LF) than patients with craniofacial hyperhidrosis after controlling for age and sex (P=0.030, P=0.004, P=0.041, and P=0.022, respectively). More sympathetic nervous predominance was found in craniofacial type (P=0.019). Low degree of CH had significantly greater RMSSD (P=0.047), and high degree of CH showed more sympathetic nervous predominance (P=0.006). Multivariate analysis showed the type and expansion of sympathicotomy were significant factors for CH (P=0.001 and P=0.028, respectively). The neural network (NN) algorithm outperformed and showed a 0.961 accuracy, 0.961 F1 score, 0.961 precision, 0.961 recall, and 0.972 area under the curve (AUC) for classification of hyperhidrosis type. The random forest (RF) model outperformed showed a 0.852 accuracy, 0.853 F1 score, 0.856 precision, 0.852 recall, and 0.914 AUC for prediction of the degree of CH.ConclusionsThe present study showed the machine learning algorithm can classify types and predict CH after sympathicotomy for primary hyperhidrosis with considerable accuracy. Further large-scale studies are needed to validate the findings and provide management guidelines for primary hyperhidrosis.

Project description:BackgroundR4+R5 sympathicotomy is one of the standard surgical treatments for primary palmar axillary hyperhidrosis (PAH), but the reported outcomes vary. Anatomical variation of sympathetic ganglia is hypothesized to be a cause for this phenomenon. The sympathetic ganglia could be visualized via near-infrared (NIR) fluorescent thoracoscopy, we utilize this novel technique to observe the anatomical variation of sympathetic ganglia T3 and T4 and investigate its relationship with surgical outcomes.MethodsThis is a prospective multi-center cohort study. All patients received intravenous indocyanine green (ICG) infusion 24 hours preoperatively. Anatomical variation of sympathetic ganglia T3 and T4 was observed via fluorescent thoracoscopy. Standard R4+R5 sympathicotomy was performed regardless of anatomical variation. Patients were followed up for the therapeutic outcome.ResultsOne hundred and sixty-two patients in total were enrolled in this study and 134 patients with bilateral clearly visualized thoracic sympathetic ganglia (TSG) were included. The success rate of fluorescent imaging of thoracic sympathetic ganglion was 82.7%. The T3 ganglion was shifted downward on 32 sides (11.9%) and no upward-shifted ganglion was identified. The T4 ganglion was shifted downward on 52 sides (19.4%) and no upward-shifted ganglion was identified. All patients underwent R4+R5 sympathicotomy and no perioperative death or severe complication occurred. The total improvement rates on palmar sweating at short-term and long-term follow-up were 98.1% and 95.1%, respectively. There were significant differences between T3 normal and T3 variation subgroups both in short-term (P=0.049) and long-term (P=0.032) follow-ups. The total improvement rates on axillary sweating at short-term and long-term follow-ups were 97.0% and 89.6%, respectively. No significant difference was found between T4 normal and T4 variation subgroups both in short-term and long-term follow-ups. No significant difference was found between normal and variation subgroups on the degree of compensatory hyperhidrosis (CH).ConclusionsNIR fluorescent thoracoscopy provides clear identification of anatomical variations of sympathetic ganglia during R4+R5 sympathicotomy. The improvement of palmar sweating was significantly affected by anatomical variation of T3 sympathetic ganglia.

Dataset Information

Thoracoscopic sympathetic block to predict compensatory hyperhidrosis in primary hyperhidrosis.

Background

Methods

Results

Conclusions

Publications

Thoracoscopic sympathetic block to predict compensatory hyperhidrosis in primary hyperhidrosis.

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