title: Ramicotomy in association with endoscopic sympathetic blockade in the treatment of axillary hyperhidrosis.
abstract: BACKGROUND
  The use of endoscopic sympathetic blockade (ESB) to treat axillary hyperhidrosis (AH) has become more widespread recently. ESB of the T3 and T4 ganglia is more effective, although it results in a higher incidence of compensatory sweating (CS) than ESB of T4 alone. To reduce CS and improve the level of satisfaction and therapeutic success of ESB, we performed T3 ramicotomy in association with T4 ESB.
  
  
  METHODS
  Ninety patients with axillary hyperhidrosis were randomized into 3 groups of 30 patients-group A (T3 and T4 ESB), group B (T4 ESB), and group C (T4 ESB in association with T3 ramicotomy)--and evaluated for CS, therapeutic success and degree of satisfaction 7 days, 6 months, and 1 year after the procedure.
  
  
  RESULTS
  CS was observed in 72 patients (80%) and classified as minor in 63 (70%), moderate in 7 (7.8%), and severe in 2 (2.2%). These results were not statistically significant. There was a higher proportion of remission of symptoms and therapeutic success in group B (100%, P=0.008). Forty-seven patients (52.2%) considered themselves very satisfied, 41 (43.3%) satisfied, and only 2 (2.2%) dissatisfied with their surgery.
  
  
  CONCLUSIONS
  ESB of T4 alone was more effective than ESB of T3 and T4 together and ESB of T4 in association with T3 ramicotomy. No significant difference was found between the techniques in terms of patient satisfaction or the occurrence and degree of CS; however, in group C, CS was more intense in the thighs, whereas in group A it was more intense in other areas.
authors.affiliation: Department of Thoracic Surgery, Cajuru University Hospital, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil. paulosfguimaraes@gmailcom
authors.forename: Paulo S F
authors.initials: PS
authors.lastname: Guimarães
authors.forename: Marlos de Souza
authors.initials: Mde S
authors.lastname: Coelho
authors.forename: Rafael G
authors.initials: RG
authors.lastname: Mendes
authors.forename: Ruy F K Caetano
authors.initials: RF
authors.lastname: da Silva
authors.forename: Lucas M
authors.initials: LM
authors.lastname: Fernandes
authors.forename: William A C
authors.initials: WA
authors.lastname: Cecilio
mesh_terms: D000293:Adolescent; D000328:Adult; D001340:Autonomic Nerve Block / Q000379:methods*; D001365:Axilla; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006945:Hyperhidrosis / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D012720:Severity of Illness Index; D013562:Sympathectomy / Q000379:methods*; D013904:Thoracic Vertebrae; D016896:Treatment Outcome; D055815:Young Adult