title: Two-stage unilateral versus one-stage bilateral single-port sympathectomy for palmar and axillary hyperhidrosis.
abstract: OBJECTIVE
  Video-assisted thoracoscopic sympathectomy is currently the best treatment for palmar and axillary hyperhidrosis. It can be performed through either one or two stages of surgery. This study aimed to evaluate the operative and postoperative results of two-stage unilateral vs one-stage bilateral thoracoscopic sympathectomy.
  
  
  METHODS
  From November 1995 to February 2011, 270 patients with severe palmar and/or axillary hyperhidrosis were recruited for this study. One hundred and thirty patients received one-stage bilateral, single-port video-assisted thoracoscopic sympathectomy (one-stage group) and 140, two-stage unilateral, single-port video-assisted thoracoscopic sympathectomy, with a mean time interval of 4 months between the procedures (two-stage group).
  
  
  RESULTS
  The mean postoperative follow-up period was 12.5 (range: 1-24 months). After surgery, hands and axillae of all patients were dry and warm. Sixteen (12%) patients of the one-stage group and 15 (11%) of the two-stage group suffered from mild/moderate pain (P = 0.8482). The mean operative time was 38 ± 5 min in the one-stage group and 39 ± 8 min in the two-stage group (P = 0.199). Pneumothorax occurred in 8 (6%) patients of the one-stage group and in 11 (8%) of the two-stage group. Compensatory sweating occurred in 25 (19%) patients of the one-stage group and in 6 (4%) of the two-stage group (P = 0.0001). No patients developed Horner's syndrome.
  
  
  CONCLUSIONS
  Both two-stage unilateral and one-stage bilateral single-port video-assisted thoracoscopic sympathectomies are effective, safe and minimally invasive procedures. Two-stage unilateral sympathectomy can be performed with a lower occurrence of compensatory sweating, improving permanently the quality of life in patients with palmar and axillary hyperhidrosis.
authors: Division of Thoracic Surgery, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy. mohsen.ibrahim@uniroma1.it
authors: Mohsen
authors: M
authors: Ibrahim
authors: Cecilia
authors: C
authors: Menna
authors: Claudio
authors: C
authors: Andreetti
authors: Anna Maria
authors: AM
authors: Ciccone
authors: Antonio
authors: A
authors: D'Andrilli
authors: Giulio
authors: G
authors: Maurizi
authors: Camilla
authors: C
authors: Poggi
authors: Camilla
authors: C
authors: Vanni
authors: Federico
authors: F
authors: Venuta
authors: Erino Angelo
authors: EA
authors: Rendina
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D006945:Hyperhidrosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010149:Postoperative Pain / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013546:Sweating; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Compensatory sweating; Palmar and axillary hyperhidrosis; Video-assisted thoracoscopic sympathectomy