Palmo-aksiller hiperhidrozis tedavisinde videotorakoskopik sempatektominin etkinliği: Yaşam kalitesi değişimi ve hasta memnuniyeti

GİRİŞ VE AMAÇ: Primer hiperhidrozis, kişinin sosyal yaşantısını ciddi şekilde kısıtlayan aşırı terleme durumudur. Palmo-axiller hiperhidrozis nedeniyle videotorakoskopik sempatektomi uygulanan hastalarda postoperatif komplikasyonlar, hasta memnuniyeti ve yaşam kalitesi değişikliğini ortaya koymayı amaçladık. YÖNTEM: primer palmo-axiller hiperhidrozis nedeniyle 251 videotorakoskopik sempatektomi ameliyatı uygulanan 126 hasta analiz edildi. Veriler, postoperatif komplikasyonlar ve yaşam kalitesini etkileyen faktörler açısından retrospektif incelendi. Kompansatuar hiperhidrozis insidansı ve hasta memnuniyeti ilişkisi analiz edildi. BULGULAR: Hastaların %53.2 'ü (n:67) kadın ve % 46.8'i (n:59) erkek idi. Ortalama yaş 24.3±7 (mim.max:15-51), Body Mass Index 23.5±4 (min-max:16.9-34.9).Ortalama hastanede kalış süresi 1.3±0.9 gündü (Min-Max: 1-6). Toplam 13 (%10.3) hastada komplikasyon gözlendi. En sık görülen komplikasyon pnömotoraks idi (n:10). Postoperatif komplikasyonları etkileyen önemli prognostik faktör saptanmadı (p<0.05). Yirmi üç hastada (%18.3) kompansatuar hiperhidrozis gözlendi (hafif düzeyde n:14, orta düzeyde n:9). CH en sık sırt ve ayak bölgesinde izlendi (n:14). Kompansatuar hiperhidrozis ile hasta memnuniyeti arasında anlamlı ilişkili bulundu (p<0.001). Videotorakoskopik sempatektomi sonrası tüm hastaların yaşam kalitesinde istatistiksel olarak anlamlı iyileşme gözlendi (p<0.001). SONUÇ: Videotorakoskopik sempatektomi palmo-aksiller hiperhidrozis hastalarında posteperatif yaşam kalitesini artırmaktadır. T3 ve T3-T4 seviyelerinde yapılan sempatektomilerde komplikasyon oranı düşük olup başarı şansı oldukça yüksektir. Kompansatuar hiperhidrozis şiddeti arttıkça hasta memnuniyeti azalır.

Anahtar Kelimeler:

Hyperhidrosis, sympathectomy, compensatory hyperhidrosis, thoracoscopy, quality of life

Efficacy of videothoracoscopic sympathectomy for palmo-axillary hyperhidrosis: Quality of Life Change and patient satisfaction

INTRODUCTION: Primary hyperhidrosis is a condition of excessive sweating that severely limits a person's social life. We aimed to investigate factors affecting the quality of life and patient satisfaction in patients undergoing videothoracoscopic sympathectomy for palmo-axillary hyperhidrosis. METHODS: We evaluated 126 patients who underwent videothoracoscopic sympathectomy for primary palmo-axillary hyperhidrosis. The data were analyzed retrospectively in terms of postoperative complications and factors affecting the quality of life. RESULTS: A total of 251 videothoracoscopic sympathectomy operations were performed, 53.2% (n:67) of the patients were female and 46.8% (n:59) were male. The mean age was 24.3±7 (min-max:15-51), whereas the mean body mass index was 23.5±4 (min-max:16.9-34.9). The mean length of hospital stay was 1.3±0.9 days (Min-Max: 1-6). Complications were observed in a total of 13 (10.3%) patients. The most common complication was pneumothorax (n:10). Compensatory hyperhidrosis was observed in 23 patients (18.3%). A significant correlation was detected between compensatory hyperhidrosis and patient satisfaction (p<0.001). A statistically significant improvement was observed in the quality of life of all patients after videothoracoscopic sympathectomy (p<0.001). CONCLUSION: Videothoracoscopic sympathectomy improves the postoperative quality of life in patients with palmo-axillary hyperhidrosis. The complication rate is low, and the chance of success is quite high in sympathectomies performed at T3 and T3-T4 levels. As the severity of sweating increased, patient satisfaction decreased.

Keywords:

compensatory hyperhidrosis, quality of life, Hyperhidrosis, sympathectomy, thoracoscopy,

PDF

___

1. Liu Y, Weng W, Tu Y, Wang J; Chinese Expert Committee on Palmar Hyperhidrosis. Chinese expert consensus on the surgical treatment of primary palmar hyperhidrosis (2021 version). Chin Med J (Engl). 2022 Jun 5;135(11):1264-1271. doi: 10.1097/CM9.0000000000002198.
2. Soares TJ, Dias PG, Sampaio SM. Impact of Video-Assisted Thoracoscopic Sympathectomy and Related Complications on Quality of Life According to the Level of Sympathectomy. Ann Vasc Surg. 2020 Feb;63:63-67.e1. doi: 10.1016/j.avsg.2019.07.018.
3. Toolabi K, Parsaei R, Farid R, Zamanian A. Endoscopic thoracic sympathotomy for primary hyperhidrosis: predictors of outcome over a 10-year period. Surg Endosc. 2022 May;36(5):3585-3591. doi: 10.1007/s00464-021-08684-8.
4. Silva SLD Sobrinho, Fiorelli RKA, Morard MRS. Evaluation of the quality of life of patients with primary hyperhidrosis submitted to videothoracoscopic sympathectomy. Rev Col Bras Cir. 2017 Jul-Aug;44(4):323-327. Portuguese, English. doi: 10.1590/0100-69912017004005.
5. Vannucci F, Araújo JA. Thoracic sympathectomy for hyperhidrosis: from surgical indications to clinical results. J Thorac Dis. 2017 Apr;9(Suppl 3):S178-S192. doi: 10.21037/jtd.2017.04.04.
6. Salim EF, Ali GA. Impact of Thoracoscopic T2 Sympathectomy on Patients With Primary Palmar and Axillary Hyperhidrosis. Ann Thorac Surg. 2018 Oct;106(4):1032-1037. doi: 10.1016/j.athoracsur.2018.05.023.
7. de Campos JR, Kauffman P, Werebe Ede C, Andrade Filho LO, Kusniek S, Wolosker N, et al. Quality of life, before and after thoracic sympathectomy: report on 378 operated patients. Ann Thorac Surg. 2003 Sep;76(3):886-91. doi: 10.1016/s0003-4975(03)00895-6.
8. Yang C, Li Z, Bai H, Mao H, Li JX, Wu H, et al. Long-Term Efficacy of T3 Versus T3+T4 Thoracoscopic Sympathectomy for Concurrent Palmar and Plantar Hyperhidrosis. J Surg Res. 2021 Jul;263:224-229. doi: 10.1016/j.jss.2020.11.064.
9. Xie H, Lu T, Zhu Y, Zhu D, Wei T, Yuan G, et al. A retrospective cohort study of T3 versus T4 thoracoscopic sympathectomy for primary palmar hyperhidrosis and primary palmar hyperhidrosis with axillary and plantar sweating. Wideochir Inne Tech Maloinwazyjne. 2020 Sep;15(3):488-495. doi: 10.5114/wiitm.2019.89656.
10. Cerfolio RJ, De Campos JR, Bryant AS, Connery CP, Miller DL, DeCamp MM, et al. The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg. 2011 May;91(5):1642-8. doi: 10.1016/j.athoracsur.2011.01.105.
11. Dogru MV, Sezen CB, Girgin O, Cansever L, Kocaturk CI, Metin M, et al. Is there any relationship between quality of life and the level of sympathectomy in primary palmar hyperhidrosis? Single-center experience. Gen Thorac Cardiovasc Surg. 2020 Mar;68(3):273-279. doi: 10.1007/s11748-019-01210-7.
12. Yazbek G, Ishy A, Alexandrino da Silva MF, Sposato Louzada AC, de Campos JRM, Kauffman P, et al. Evaluation of compensatory hyperhidrosis after sympathectomy: The use of an objective method. Ann Vasc Surg. 2021 Nov;77:25-30. doi: 10.1016/j.avsg.2021.05.014.
13. Panhofer P, Ringhofer C, Gleiss A, Jakesz R, Prager M, Bischof G, et al. Quality of life after sympathetic surgery at the T4 ganglion for primary hyperhidrosis: clip application versus diathermic cut. Int J Surg. 2014 Dec;12(12):1478-83. doi: 10.1016/j.ijsu.2014.11.018.
14. de Campos JR, da Fonseca HV, Wolosker N. Quality of Life Changes Following Surgery for Hyperhidrosis. Thorac Surg Clin. 2016 Nov;26(4):435-443. doi: 10.1016/j.thorsurg.2016.06.008.
15. de Campos JR, Wolosker N, Takeda FR, Kauffman P, Kuzniec S, Jatene FB, et al. The body mass index and level of resection: predictive factors for compensatory sweating after sympathectomy. Clin Auton Res. 2005 Apr;15(2):116-20. doi: 10.1007/s10286-005-0259-6
16. Yoon SH, Rim DC. The selective T3 sympathicotomy in patients with essential palmar hyperhidrosis. Acta Neurochir (Wien). 2003 Jun;145(6):467-71; discussion 471. doi: 10.1007/s00701-003-0011-8.
17. Horslen LC, Wilshire CL, Louie BE, Vallières E. Long-Term Impact of Endoscopic Thoracic Sympathectomy for Primary Palmar Hyperhidrosis. Ann Thorac Surg. 2018 Oct;106(4):1008-1012. doi: 10.1016/j.athoracsur.2018.04.063.