Systemic Effect of Sympathectomy in the Treatment of Localized Hyperhidrosis

Overview

Journal Updates Surg

Specialty General Surgery

Date 2025 Mar 11

PMID 40064815

Authors

Mehmet Cetin

Furkan Sural

Ilteris Turk

Necati Solak

Kenan Sonmez

Koray Aydogdu

Affiliations

Soon will be listed here.

Abstract

Hyperhidrosis is thought to result from excessive stimulation of sweat glands due to increased sympathetic activity; however, data on systemic responses following bilateral thoracic sympathectomy as the definitive treatment have not yet been sufficiently evaluated. This study, designed as a prospective cohort investigation, included 24 patients who underwent sympathectomy for palmar and axillary hyperhidrosis at our center in 2023, along with an age-matched control group of equal size. In the sympathectomy group, pupillometry measurements were performed 1 day before surgery and on the 7th postoperative day, while the control group underwent measurements at corresponding intervals. Data from the sympathectomy group were analyzed both preoperatively and postoperatively and compared with the control group. According to the Hyperhidrosis Disease Severity Scale, all patients had severe hyperhidrosis. Sympathectomy was performed at the T3 level in 9 patients and at both T3 and T4 levels in 15 patients. The postoperative satisfaction rate was recorded as 95.8%. No statistically significant differences were observed between preoperative pupillometry measurements of the sympathectomy group and those of the control group. However, when comparing preoperative and postoperative data within the sympathectomy group, significant differences favoring increased parasympathetic activity were noted in the latency of contractions and photopic low values (p = 0.016 and p = 0.038, respectively). Our study is one of the pioneering works to objectively demonstrate, through a quantitative method, that sympathectomy for hyperhidrosis enhances the parasympathetic system response in the ocular region.

References

Kobayashi M, Kumaya Y, Hirayama Y, Oda H, Cho H, Huang C . Single-center experience of thoracoscopic sympathectomy for palmar hyperhidrosis with long-term postoperative questionnaire survey. Gen Thorac Cardiovasc Surg. 2024; 72(11):732-737. PMC: 11471702. DOI: 10.1007/s11748-024-02034-w. View

Schick C . Pathophysiology of Hyperhidrosis. Thorac Surg Clin. 2016; 26(4):389-393. DOI: 10.1016/j.thorsurg.2016.06.002. View

Gossot D, Kabiri H, Caliandro R, Debrosse D, Girard P, Grunenwald D . Early complications of thoracic endoscopic sympathectomy: a prospective study of 940 procedures. Ann Thorac Surg. 2001; 71(4):1116-9. DOI: 10.1016/s0003-4975(01)02422-5. View

Moya J, Ramos R, Morera R, Villalonga R, Perna V, Macia I . Thoracic sympathicolysis for primary hyperhidrosis: a review of 918 procedures. Surg Endosc. 2006; 20(4):598-602. DOI: 10.1007/s00464-005-0557-z. View

Miller D, Force S . Outpatient microthoracoscopic sympathectomy for palmar hyperhidrosis. Ann Thorac Surg. 2007; 83(5):1850-3. DOI: 10.1016/j.athoracsur.2006.11.030. View

Ramos R, Urena A, Rivas F, Macia I, Rosado G, Pequeno S . Impact of T3 thoracoscopic sympathectomy on pupillary function: a cause of partial Horner's syndrome?. Surg Endosc. 2011; 26(4):1146-52. DOI: 10.1007/s00464-011-2022-5. View

Kumagai K, Kawase H, Kawanishi M . Health-related quality of life after thoracoscopic sympathectomy for palmar hyperhidrosis. Ann Thorac Surg. 2005; 80(2):461-6. DOI: 10.1016/j.athoracsur.2005.03.026. View

Zhang F, Jaffe-Dax S, Wilson R, Emberson L . Prediction in infants and adults: A pupillometry study. Dev Sci. 2018; 22(4):e12780. PMC: 7294578. DOI: 10.1111/desc.12780. View

Kamudoni P, Mueller B, Salek M . The development and validation of a disease-specific quality of life measure in hyperhidrosis: the Hyperhidrosis Quality of Life Index (HidroQOL©). Qual Life Res. 2014; 24(4):1017-27. PMC: 4366556. DOI: 10.1007/s11136-014-0825-2. View

10.

Bicer G, Zor K, Kucuk E . Do static and dynamic pupillary parameters differ according to childhood, adulthood, and old age? A quantitative study in healthy volunteers. Indian J Ophthalmol. 2022; 70(10):3575-3578. PMC: 9789821. DOI: 10.4103/ijo.IJO_1254_22. View

11.

Fountoulakis K, Kaprinis G, Fotiou F . Is there a role for pupillometry in the diagnostic approach of Alzheimer's disease? a review of the data. J Am Geriatr Soc. 2003; 52(1):166-8. DOI: 10.1111/j.1532-5415.2004.52030_7.x. View

12.

Bicer G, Kurt A, Zor K . Efficacy of automatic pupillometry as a screening technique to detect autonomic dysfunction in bipolar disorder. Clin Exp Optom. 2022; 106(8):896-900. DOI: 10.1080/08164622.2022.2145182. View

13.

Tekin K, Sekeroglu M, Kiziltoprak H, Doguizi S, Inanc M, Yilmazbas P . Static and dynamic pupillometry data of healthy individuals. Clin Exp Optom. 2018; 101(5):659-665. DOI: 10.1111/cxo.12659. View

14.

Ambrogi V, Campione E, Mineo D, Paterno E, Pompeo E, Mineo T . Bilateral thoracoscopic T2 to T3 sympathectomy versus botulinum injection in palmar hyperhidrosis. Ann Thorac Surg. 2009; 88(1):238-45. DOI: 10.1016/j.athoracsur.2009.04.003. View

15.

Wei Y, Xu Z, Li H . Quality of life after thoracic sympathectomy for palmar hyperhidrosis: a meta-analysis. Gen Thorac Cardiovasc Surg. 2020; 68(8):746-753. DOI: 10.1007/s11748-020-01376-5. View

16.

Felisberto Jr G, Cataneo A, Cataneo D . Thoracic sympathectomy for the treatment of primary axillary hyperhidrosis: systematic review and proportional meta-analysis. Ann Med. 2021; 53(1):1216-1226. PMC: 8293952. DOI: 10.1080/07853890.2021.1953126. View

17.

Toolabi K, Parsaei R, Farid R, Zamanian A . Endoscopic thoracic sympathotomy for primary hyperhidrosis: predictors of outcome over a 10-year period. Surg Endosc. 2021; 36(5):3585-3591. DOI: 10.1007/s00464-021-08684-8. View

18.

Cerfolio R, De Campos J, Bryant A, Connery C, Miller D, DeCamp M . The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg. 2011; 91(5):1642-8. DOI: 10.1016/j.athoracsur.2011.01.105. View

19.

Miller D, Bryant A, Force S, Miller Jr J . Effect of sympathectomy level on the incidence of compensatory hyperhidrosis after sympathectomy for palmar hyperhidrosis. J Thorac Cardiovasc Surg. 2009; 138(3):581-5. DOI: 10.1016/j.jtcvs.2009.03.059. View

20.

Diamante Leiderman D, De Campos J, Kauffman P, Tedde M, Yazbek G, Teivelis M . The relation between age and outcomes of thoracic sympathectomy for hyperhidrosis: The older the better. J Thorac Cardiovasc Surg. 2018; 156(4):1748-1756. DOI: 10.1016/j.jtcvs.2018.05.084. View