Endoscopic versus trans-axillary thoracic sympathectomy for primary axillary and palmar hyperhidrosis and facial blushing

Abstract

Abstract
Background: Thoracic sympathectomy is a frequent treatment performed across the world to treat facial flushing as well as primary axillary and palmar hyperhidrosis. Thoracic sympathectomy is indicated by sympathetic dystrophy, cardiac disease, and blue finger syndrome. Although thoracic sympathectomy can be used to treat finger vasospastic disorders, it has been less successful. Therefore, effective treatment is necessary to cure this complication.
Objective: The aim of the research explores the effective treatment option from endoscopic intervention and trans-axillary thoracic sympathectomy to treat primary axillary, palmar hyperhidrosis and facial blushing.
Materials and method: Between 2014 and 2020, a total of 50 thoracic sympathectomies were performed in Huangdao District Hospital., with 10 being surgical and 40 endoscopic. X-ray of the chest was performed to rule out apical pleural syndrome, which indicates the existence of an adhesion. The surgeries performed on the hospitalised patients were carried out unilaterally. A contralateral intervention was conducted 6–8 weeks after the operation. The surgical sympathectomy was performed using the trans-axillary route. Operations were conducted, October 2014 to April 2017, followed by thoracoscopic therapy. Trans-axillary techniques were employed to access the thoracic sympathectomy, which improved aesthetic outcomes and allowed for better anatomical exposure. For thoracoscopic sympathectomy, the patients were sedated with a double-lumen endotracheal tube. They were evaluated to determine their level of satisfaction with the entire therapy regimen.
Result: During the surgery no death was reported. In trans-axillary thoracic sympathectomy procedure, out of 15 patients, one patient had post-operative facial blushing. The efficiency of the blushing was 93.32%. In endoscopic intervention treatment, 24 patients have undergone surgery for hyperhidrosis of the palms and axillae with or without blushing. All the patients were satisfied with the treatment results. Three patients were found to have moderate sweating after ten months of operation. No condition was considered problematic as compared to the pre-operation stage. The sympathetic activity relapse rate was 14.3%. Compensatory sweating was found among 67% of patients. Gustatory sweating and phantom sweating were found among 37.5% and 29% of the patients respectively.
Conclusions: There were no patients were considered these side effects troublesome. The outcomes of the research proved that there is not much variation in results. However, there is no difference in the efficiency between the endoscopic intervention and tarns-axillary thoracic sympathectomy. The endoscopic efficiency is linked with the short hospital stay period, less pain, and fast recovery. It’s concluded that thoracic sympathectomy is considered a better choice for treating excessive facial blushing and primary hyperhidrosis. [Ethiop. J. Health Dev. 2021; 35(4) 419-422]
Keywords: Thoracic Sympathectomy; Blushing Hyperhidrosis; Physiological response; Ganglia