Sympathetic skin response and patient satisfaction on long-term follow-up after thoracoscopic sympathectomy for hyperhidrosis.
OBJECTIVE
To determine effect of sympathectomy for hyperhidrosis on sympathetic skin response (SSR) during long-term follow-up. Patient satisfaction was assessed and surgical complications noted.


METHODS
Prospective, Open, Non-randomised study.


METHODS
Patients who had undergone bilateral thoracoscopic sympathectomy for hyperhidrosis underwent postoperative assessment of SSRs. A 15 mA stimulus was applied over the median nerve contralateral to the sympathectomy and evoked electrodermal activity was recorded from the sympathectomised palm using a Dantec Counterpoint Mk 2. Patient satisfaction with surgery was assessed by questionnaire and visual analogue score (0-1.0).


RESULTS
Of 26 patients, 21 were female. Mean (range) age was 23 (9-36) years. Mean (range) follow up was 39 (4-138) months. 12% of cases had residual or recurrent symptoms. Median (range) patient satisfaction was 0.83 (0.06-1.0). In 7/52 palms recurrent SSRs were not detected. Repeated measures analysis of variance found amplitude of SSR to be of low significance with respect to time since surgery (F = 0.48; p = 0.49) and incidence of compensatory sweating (F = 2.38; p = 0.14).


CONCLUSIONS
Thoracoscopic sympathectomy for hyperhidrosis is an effective procedure. Following sympathectomy SSRs are not permanently abolished, but return of SSRs does not correspond with symptom recurrence. As such, SSRs are a poor tool for objective assessment of long-term outcome following sympathectomy.
Lewis
D R
DR
Department of Surgery, Bristol Royal Infirmary.
Irvine
C D
CD
Smith
F C
FC
Lamont
P M
PM
Baird
R N
RN
D000293:Adolescent; D000328:Adult; D002648:Child; D004558:Electric Stimulation; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D005712:Galvanic Skin Response; D006801:Humans; D006945:Hyperhidrosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011446:Prospective Studies; D012008:Recurrence; D012867:Skin / Q000294:innervation*; D013562:Sympathectomy; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D013906:Thoracoscopy