Axillary hyperhidrosis and osmidrosis treated by ultrasonic surgical aspiration compared with transthoracic endoscopic sympathectomy.
BACKGROUND
Axillary hyperhidrosis (AH) and/or osmidrosis (AO) are characterized by excessive sweating and/or malodor that originate from axillary sweat glands. The condition often causes emotional, social, and professional embarrassment. Although there have been various therapeutic modalities, none has proved entirely satisfactory. In this report, we compared the results of 2 minimally invasive therapeutic modalities (transthoracic endoscopic sympathectomy [TES] and ultrasonic surgical aspiration [USA]) in terms of efficacy and complications and demonstrated which is the better choice of treatment of AH and AO.


METHODS
In the past years, we have treated patients of AH and/or AO with TES by electrocoagulation of T2 and T3 segment of the thoracic sympathetic trunk. On the other hand, we treated patients with AH and/or AO by using USA with endoscopic confirmation for adequate removal of axillary secretion glands and subcutaneous fat.


RESULTS
During the past 7 years, 20 patients with AH and/or AO were treated with TES, in which AH obtained adequate relief but AO with only partial alleviation. Only 2 patients showed clinical significant recurrence in 2 years' follow-up. About one half of the patients were complicated with compensatory hyperhidrosis. From May 2005 to April 2006, 55 patients with AO and/or AH were treated with USA. Most patients (91%) obtained adequate relief of AH and AO with minimal wound complications. In the 1-year follow-up, no clinical recurrence was encountered except 2 patients who belonged to the early series of this study.


CONCLUSIONS
Based on our clinical experience with the 2 therapeutic techniques (TES and USA), USA is direct removal of local target tissue (secretion glands) and can avoid major wound complications. It has been proven that USA is more logical and effective than TES, which is less effective and often complicated with unwanted compensatory hyperhidrosis. Ultrasonic surgical aspiration aided with endoscopic confirmation is a minimally invasive technique and is considered as the treatment of choice for AO and/or AH.
Lee
Han-Chung
HC
Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan, ROC.
Chen
Chun-Chung
CC
Lee
Wen-Yuan
WY
Chuang
Hao-Uhe
HU
Kao
Ming-Chien
MC
D000293:Adolescent; D000328:Adult; D000556:Ambulatory Surgical Procedures; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D013396:Suction / Q000379:methods*; D013562:Sympathectomy / Q000009:adverse effects; D014464:Ultrasonic Therapy / Q000009:adverse effects; D055815:Young Adult