Video assisted thoracoscopic re-sympathetic surgery in the treatment of re-sweating hyperhidrosis.
OBJECTIVE
The characteristics and causes of re-sweating after sympathetic surgery in hyperhidrosis patients have yet to be clearly documented due primarily to low incidence of re-sympathetic surgery. The purpose of this study is to identify the causes of re-sweating following sympathetic surgery, and to assess the outcomes of re-sympathetic surgery.


METHODS
From February 1997 to July 2003, 36 patients underwent re-sympathetic surgery in order to treat re-sweating. Patients originally underwent sympathetic surgery due to facial (14 cases), palmar (21 cases), and axillary (1 case) hyperhidrosis.


RESULTS
Sympathectomy was performed as a primary surgical intervention in 7 cases (19.4%), sympathicotomy in 12 cases (33.3%), and sympathetic clipping in 17 cases (47.3%). Thirteen patients complained of re-sweating on both sides, and 23 patients exhibited unilateral re-sweating. The onset of re-sweating occurred after an average of 3.1+/-3.4 months (range, 1-12 months) after the operation. The causes of re-sweating after sympathetic surgery included an intact sympathetic chain in 4 cases (11.1%), incomplete resection in 6 cases (16.7%), partial reattachment in 6 cases (16.7%), improper ganglion location in 4 cases (11.1%), clip slipping out in 11 cases (30.5%), and unknown in 5 cases (13.9%). Twenty-seven patients (75.0%) exhibited re-sweating within 3 months, and 9 patients (25.0%) experienced re-sweating after 6 months. During the second operation, sympathicotomy was performed in 20 cases (55.6%) and sympathetic clipping in 16 cases (44.4%) in which 32 patients (88.9%) reported decreased sweating.


CONCLUSIONS
Surgical errors during the initial operation constituted the main cause of re-sweating following sympathetic surgery. Re-sympathetic surgery was necessary in order to treat re-sweating, and was associated with favorable outcomes.
Kim
Do Hyung
DH
Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital, Daejeon, South Korea.
Paik
Hyo Chae
HC
Lee
Doo Yun
DY
D000293:Adolescent; D000328:Adult; D001365:Axilla; D005145:Face; D005260:Female; D005500:Follow-Up Studies; D006225:Hand; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D008297:Male; D019300:Medical Errors; D008875:Middle Aged; D017060:Patient Satisfaction; D012008:Recurrence; D012086:Reoperation; D013525:Surgical Instruments; D013562:Sympathectomy / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted; D017211:Treatment Failure