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An assessment of plantar hyperhidrosis after endoscopic thoracic sympathicolysis

^a Department of Thoracic Surgery, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Spain
^b Department of Thoracic Surgery and Unit of Human Anatomy, Hospital Universitari de Bellvitge, School of Medicine, University of Barcelona, L’Hospitalet de Llobregat, Spain
^c Department of Preventive Medicine and Biostatistics, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Spain
^d Department of Anesthesiology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Spain

Received 10 July 2008; received in revised form 25 February 2009; accepted 27 February 2009.

^_* Corresponding author. Address: Servei de Cirurgia Toràcica, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Spain. Tel.: +34 932607700; fax: +34 932607983. (Email: ricardramos{at}ub.edu).

Background: Endoscopic bilateral thoracic sympathicolysis (EBTS) is an effective and minimally invasive procedure used for patients with primary hyperhidrosis. The purpose of this study was to examine plantar hyperhidrosis before and after EBTS. Methods: A total of 198 patients with primary hyperhidrosis underwent 396 thoracoscopic sympathicolysis of ganglia T2–T3 in a prospective study. All completed a preoperative questionnaire, followed by a second questionnaire 12 months after the operation. The questionnaires evaluated sweating in the different body areas. Only the zones of anhydrosis were considered in delimiting the cutaneous expression of sympathetic ganglia T2–T3. Results: Redistribution of perspiration as reported by the patients comprised significant reductions in palmar and axillary hyperhidrosis, and an increase in the zone of the trunk and popliteal region. The incidence of plantar anhydrosis and plantar hypohidrosis was 30.3% and 20.7%, respectively (p < 0.001). Conclusions: EBTS is followed by redistribution of body perspiration, with, and important, plantar anhydrosis and hypohidrosis. Although EBTS is the standard treatment for palmar primary hyperhidrosis, we must continue studying baseline sympathetic activity in patients affected by primary hyperhidrosis and the neuroanatomy of the sympathetic system to understand the redistribution of sweating and decrease of hyperhidrosis in the zones regulated by mental or emotional stimuli.

Key Words: Hyperhidrosis • Redistribution of sweating • Thoracoscopic sympathicolysis