N. Saiz-sapena et al., Operative monitoring of hand and axillary temperature during endoscopic superior thoracic sympathectomy for the treatment of palmar hyperhidrosis, EURO J SURG, 166(1), 2000, pp. 65-69
Objective: To find out how much the temperature in the palm rises after upp
er thoracic sympathectomy for palmar hyperhidrosis, and correlate the tempe
rature with the outcome.
Design: Retrospective study.
Setting: University hospital, Spain.
Subjects: 73 patients (34 women and 39 men, age range 16-42 years, mean 26)
who were operated for palmar hyperhidrosis between 1 January 1995 and 31 D
ecember 1997.
Interventions: Bilateral thoracic endoscopic sympathectomy during which the
temperature was monitored on the skin of both axillae and thenar eminences
, and in the oesophagus.
Main outcome measures: Morbidity, alleviation of hyperhidrosis, recurrence
rate, and differences in temperature postoperatively.
Results: There was minor bleeding during operation in 25 cases (34%), but i
n only 4 was it sufficient to require insertion of a drain; 2 patients deve
loped transient Horner's syndrome; but the most common complication was com
pensatory hyperhidrosis (n = 52, 71%). In only 5 was this other than mild a
nd required treatment with aluminium chloride in ethanol 25%. Palmar hyperh
idrosis was alleviated in all cases, axillary sweating was considerably imp
roved, and there was improvement in the feet in 56 (77%). There were 5 recu
rrences, all on the right side, during a mean follow up of 9 months (range
2-36), but in no case was the sweating severe. In almost all cases the temp
erature of the palm was less than that of the axilla before operation by a
mean (SD) of 0.9 (0.3)degrees C. The rise in temperature varied from 1.7 (0
.4)degrees C: to 2.6 (0.4)degrees C. In the 5 patients who developed recurr
ences the increase was less (0.5 (0.4)degrees C).
Conclusion: Thoracic endoscopic sympathectomy is safe, simple, and effectiv
e: in treating palmar hyperhidrosis that has not responded to conservative
treatment. Intradermal monitoring is an accurate and cost-effective way of
monitoring temperature during operation. Although it is essential to achiev
e a rise in temperature of 1 degrees C, our most important finding was that
the final temperature in both hands and axillae should be above 35 degrees
C and as near as possible to 36 degrees C.