21 de Fevereiro de 2020 - 23:50
Medical Reference
[-] Hyper-Hidrosis
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HYPERHIDROSIS / COMPLICATIONS
Hyperhidrosis - Excessive perspiration


POSSIBLE COMPLICATIONS OF VIDEOTHORACOSCOPY THORACIC SYMPATHECTOMY
Complications related to this procedure have sporadically been described but their prevalence had been inferior to 1%. This rate is inferior when compared to the conventional surgery and surgeries performed by videothoracoscopy to treat other diseases.
 
HORNER SYMDROME (0-1,2%)
Claude-Bernard-Horner Syndrome (miosis, space between upper and lower eyelids diminished, enophthalmia) is caused by direct lesion of the stellate ganglion (eight cervical sympathetic ganglion plus first sympathetic ganglion) or by the transmission of heat and electricity to it when using an electric cautery. This syndrome can be definitive when the star ganglion is resected or coagulated and temporary when is caused by local inflammatory reaction.

Claude Bernard Horner Syndrome was more prevalent previous to videothoracoscopy era specially when it was performed through the supraclavicular region (neck). The rate of this syndrome varies from 1 to 1,2% but with the utilization of videothoracoscopy authors report a rate close to 0%. We did not have such complication in about 1200 surgeries performed in approximately 600 patients.
 
BRACHIAL PLEXUS LESION
The brachial plexus is a group of nerve roots that descend from the neck to the shoulder and superior limb. A lesion may cause muscular weakness, formication and paralysis. In this kind of surgery the plexus is not injured because it is not part of the surgical field, but these symptoms are produced by the stretching of the plexus because of the position –half-seated on surgery table with elevated arms. It may occur paresis of superior limb (0-0,4%) or paresthesia of superior limb (0-0,4%).
 
COMPLICATIONS AND ITS PREVALENCES IN MEDICAL WORLD LITERATURE
Chylothorax (presence of lymph in the pleural cavity) 0-0,8%;
hemothorax (collection of blood in the pleural cavity) 0-0,8%;
pnemothorax needing drainage (collection of air in the pleural cavity) 0,4-1%;
infection of surgical wound (0-1,25%);
pleura hemorrhage (0-0,8%);
atelectasis (0-0,5%);
surgical emphysema (0-2,5%);
pulmonary embolism (0-0,08%);
persistent aerial escape (0-1,25%);
pulmonary lesion (0,0-0,47%);
infection of the pleural cavity /empyema (0%).
 
PLANTAR HYPERHIDROSIS – LUMBAR SYMPATHECTOMY
Patients presenting ISOLATED PLANTAR HYPERHIDROSIS and the ones that were not healed from ASSOCIATED PLANTAR HYPERHIDROSIS may be submitted to LUMBAR SYMPATHECTOMY. It is not clear enough if patients with compensatory perspiration after thoracic sympathectomy for Plantar Hyperhidrosis with no improvement have indication for Lumbar Sympathectomy.
 
GLOBAL RESULTS OF VIDEOTHORACOSCOPY THORACIC SYMPATHECTOMY THERAPEUTIC SUCCESS – 5 YEARS OF SATISFAC
The results are evaluated in relation to “stop sweating” and not necessarily correspond to satisfaction with surgery. The therapeutic success rates (STOP SWEATING) were of 90.9% for craniofacial hyperhidrosis, 99,5% for axillar hyperhidrosis and 32% for associated plantar hyperhidrosis. The satisfaction rates varied from 94-97% when globally considered.

For a better evaluation of results after the Thoracic Sympathectomy for the treatment of Hyperhidrosis, a pre and postoperative quality of life questionnaire (social, personal, emotional, etc.) may be used. Quality of life improvement after the surgical treatment of hyperhidrosis varies between 80 and 86,4%.

The table bellow analyzes the degree of satisfaction.
 
TABLE 1
 
CONCLUSION
The excellent result achieved with VIDEOTHORACOSCOPY THORACIC SYMPATHECTOMY is the responsible for the joy, satisfaction and euphoria presented by patients who carried PALMAR, AXILLAR, CRANIFACIAL and ASSOCIATED PLANTAR HYPERHIDROSIS. There was a change in their behaviour affecting positively their personal and working relationships. That is why it is indicated to all suffers of Hyperhidrosis (palmar, axillar, craniofacial and associated plantar) who want to be free from the discomfort and limitations caused by this disease.
 
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