• Journal of Korean Neurosurgical Society
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• v.30 no.4
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• pp.486-492
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• 2001

Objective : Essential hyperhidrosis is a pathological condition of excessive sweating beyond that required to cool the body, though poorly understood, originating from a dysfunction of the sympathetic nervous system. Thoracoscopic sympathectomy is the most popular treatment for upper limb hyperhidrosis, because it is a safe, effective, minimally invasive, and time-saving method. However, the common complication is the compensatory hyperhidrosis in other areas of the body, notably on the back, chest, abdomen, and buttocks. Compensatory hyperhidrosis is severe enough for some people, especially those living in a warm climate or engaging in heavy physical activities, to regret ever having had operation. The pathophysiological mechanisms underlying compensatory hyperhidrosis are incompletely understood, even though it is thought to be a truly compensatory feature related to thermoregulation of the body. Materials and Methods : we studied the clinical features of total 233 patients who were diagnosed as essential hyperhidrosis and treated with thoracoscopic sympathectomy or sympathicotomy from March 1992 to July 2000. Results : The success rate of thoracoscopic sympathetic surgery(sympathectomy or sympathicotomy) was 98.7%. The global rate of compensatory hyperhidrosis was 77% ; 84% in group T2, 3 sympathectomy, 76% in group T2 sympathectomy, 43% in group T2, 3 sympathicotomy and 59% in group T2 sympathicotomy. The rate of embarrassing or disabling compensatory sweating was significantly higher in T2 sympathectomy and in T2, 3 sympathectomy than in T2 sympathicotomy and T2, 3 sympathicotomy with significancy in statistic analysis(p<0.01). The precipitating factors of compensatory hiperhidrosis, including heat(warm weather), anxiety, stress, and exertion were noted. The compensatory hyperhidrosis was the main cause of patient dissatisfaction after thoracoscopic sympathectomy. Conclusion : The degree of compensatory hyperhidrosis is closely related to the extent of thoracic sympathectomy.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.81-86
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• 1999

Background: Essential hyperhidrosis is a condition with excessive sweating, which may be localized in any parts of the body. Thoracic sympathectomy has been a surgical procedure for the management of hyperhidrosis. Methods: We studied 30 ASA I and II patients suffering from severe hyperhidrosis. Bilateral upper thoracoscopic sympathectomy of $T_{2-4}$ was performed in 30 patients under general anesthesia. Anesthesia was induced with 2.5% thiopental sodium 5 mg/kg and succinylcholine chloride 1 mg/kg and was maintained with enflurane 1~2 Vol% and $N_2O-O_2$ mixture adjusted to maintain $SpO_2$ greater than 96%. During anesthesia, invasive arterial pressure, heart rate, EKG, $SpO_2$ and capnography were monitored. Skin temperature was measured with thermister probes attached to the index finger of each hand. An increase in temperature after cautery confirmed success of the sympathectomy. Results: There were 14 men and 16 women whose ages ranged from 16 to 46 years old (mean age 22.2). Of these patients, 13 patients had complained of palm-sole hyperhidrosis, 9 of palm-sole-axilla hyperhidrosis, 4 of palm-sole-face hyperhidrosis and 4 of palm-sole-axilla-face hyperhidrosis. The provocative factors of excessive sweating were tension and stress from interpersonal relationships. There was positive familial history in 37%. The most common complication was compensatory hyperhidrosis in 23 patients comprising 76%. Other complication included peumothorax (4 patients), hemothorax (1 patient), ipsilateral Horner's syndrome (1 patient) and paresthesia of right arm (1 patient). The degree of satisfaction was graded as good, fair and poor with 15, 12 and 3 patients, respectively. Conclusions: Thoracoscopic sympathectomy with VATS is an efficient, safe and minimally invasive surgical procedure for essential hyperhidrosis.

• Journal of Chest Surgery
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• v.32 no.2
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• pp.175-180
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• 1999

Background: Since 1992, we developed the technique for video endoscopic sympathectomy to treat palmar hyperhidrosis. It was soon proven to be a simple and effective therapy for essential hyperhidrosis. Compensatory hyperhidrosis, however, is the main cause of patient dissatisfaction after video-assisted thoracoscopic sympathectomy. According to many authors, initial satisfaction rate was high(94-98%), but it was declined with time (66%) due to mainly to embarrassing side effects. Material and Method: From January 1992 to February 1998, the thoracoscopic T2 sympathicotomy, T2 sympathectomy and T2-4 sympathectomy were performed in 315 patients suffering from Essential hyperhidrosis in the Department of Thoracic and Cardiovascular Surgery in the Respiratory Center of Yongdong Severance Hospital Seoul, Korea. Eighty-nine patients underwent T2 sympathicotomy, and Eighty-eight patients underwent division T2 sympathectomy. Result: All of the treated patients obtained satisfactory alleviation of essential hyperhidrosis. The global rate of compensatory sweating were ; 64.0% in T2 sympathicotomy, 73.8% in T2 sympathectomy and 87.8% in T2-4 sympathectomy. The rate of embarrassing or disabling compensatory sweating was significantly higher in T2 sympathicotomy 15.7%(14/89) and in T2 sympathectomy 32.8%(28/88) than in T2-4 sympathectomy 58.0%(80/138) with significancy in statistic analysis(p<0.05). Video- assisted thoracoscopic sympathectomy is an effective minimally invasive and effective procedure. Conclusion: We suggest that the incidence and degree of compensatory hyperhidrosis was closely related to the extent of thoracic sympathectomy.

• Journal of Korean Neurosurgical Society
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• v.30 no.8
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• pp.992-997
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• 2001

Objectives : Essential hyperhidrosis is a common condition characterized by excessive body sweating. Excessive sweating beyond what is necessary to maintain normal body temperature need not be considered pathological unless it interferes with one's occupation and/or life-style. The existing non-operative therapeutic options seldom give sufficient relief or show a transient effect. In this regard, the thoracic sympathectomy may provide a definitive cure. In the past, surgical procedures were highly invasive and caused significant morbidity, but the minimally invasive thoracoscopic procedure provided detailed visualization of sympathetic ganglia and is associated with minimally postoperative morbidity. Nowadays, thoracoscopic transthoracic sympathectomy is accepted as the treatment of choice for essential hyperhidrosis. In palmar hyperhidrosis, however, the level of sympathetic chain to be blocked has been somewhat obscure. It is assumed that the incidence of compensatory hyperhidrosis may closely related to the extent of thoracic sympathectomy. Material & Methods : To compare the results of posterior midline approach with endoscopic sympathectomy, and the results of T2 with T2, 3 sympathectomy or sympathicotomy, we retrospectively studied 62 patients treated for palmar hyperhidrosis between September 1993 and May 2000. We reviewed medical records and recently interviewed the patients by telephone calls. Results : The treatment effect of T2 sympathectomy is no different from T2, 3 sympathectomy. But, the incidence of compensatory hyperhidrosis is less in the T2 sympathectomy group than the T2, 3 sympathectomy group. Conclusion : Thoracoscopic sympathectomy is considered a simple, safe, and effective method for treating palmar hyperhidrosis, with a shorter operation time, fewer hospital days, and a better cosmetic result, as compared with the open approaches. However, sympathicotomy seems to provide the advantages of a limited extent of denervation and the resultant decrease of compensatory hyperhidrosis compared to sympathectomy.

• Journal of Chest Surgery
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• v.35 no.3
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• pp.223-226
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• 2002

Background: Thoracoscopic sympathicotomy is an effective treatment in essential hyperhidrosis. However, many patients suffer from compensatory hyperhidrosis. Compensatory hyperhidrosis is a very uncomfortable problem, but the mechanisms underlying compensatory hyperhidrosis are not completely understood. Material and Method: From May 1999 to June 2001, 25 cases of thoracoscopic sympathicotomy at the 2nd rib for facial hyperhidrosis and 116 cases of thoracoscopic sympathicotomy at the 3rd rib for palmar hyperhidrosis were performed in 141 patients. All of the patients were divided into noncompensatory sweating(NCS) and compensatory sweating(CS) group. Each group was investigated according to age, sex, body surface area(BSA), level of sympathicotomy and occupation. Result: The global rate of compensatory hyperhidorsis were 64.5%(91/141). There was no difference between the two groups for BSA, level of sympathicotomy and occupation. Mean age showed 23.2 years old in NCS group and 26.4 years old in CS group(p=0.09). In CS group, 46 cases were male(50.5%) and 45 cases were female(49.5%) and in NCS group, 19 cases were male(38.0%) and 31 cases were female(62.0%) (p=0.16). Conclusion: There were no available statistical data, but there was the fact that old age and male patients had the tendency for compensatory hyperhidrosis. If we have more patient group and consider the patient's family history or psychiatric problems, we will have more valuable data for compensatory hyperhidrosis.

• The Korean Journal of Pain
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• v.21 no.3
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• pp.206-210
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• 2008

Background: Although the cause of hyperhidrosis has not been the subject of close investigation, there are cases for which excessive sweating happens at the hands, feet and armpits due to hyperactivity of the sympathetic nervous system. This usually occurs in people less than 25 years old and it often causes difficulties for their social and occupational life and there is a decrease in the quality of life. Therefore, this should also be examined according to the mental state of the patient who suffers from hyperhidrosis. Methods: The Minnesota Multiple Personality Inventory was administered to 59 patients in the Hyperhidrosis Center from March, 2006 to March, 2007. The MMPI's validity and 10 clinic standards were analyzed. The results were compared according to gender and age. Results: Of the standard clinical items, psychopathy and conversion hysteria were 21.1% and 17.5%, respectively. On comparison between males (47.5%) and females (52.5%), the females had a higher score for the hypochondriasis item. The patients above 18 years old had a significantly higher level of hypochondriasis and hypomania compared to the patients below 18 years old. Conclusions: When analyzing the personality of the patients with essential hyperhidrosis with using the MMPI, it was difficult to look for relations with the mental factor. Therefore, it is necessary to develop diagnostic tests for younger people with considering the relations with the period of morbidity.

• Journal of Chest Surgery
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• v.30 no.11
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• pp.1105-1110
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• 1997

Essential hyperhidrosis is a condition with excessive sweating, which may be localized in any part of the body Excessive sweating has a strong negative impact on the qual ty of life for many persons. From June 1992 to May 1996, 211 cases of thoracoscopic thoracic sympathectomy were performed in the Department of Thoracic Surgery, Yongdong Severance Hospital, Seoul, Korea. Among the 211 cases, 192 patients had palmar hyperhidrosis, and 19 cases had facial hyperhidrosis. There were 121 males and 90 (tamales, and the ages ranged from 10 to 67 years(average: 24.82 years old). The average operation time and the average postoperative hospital stay were 91.94 minutes and 4.31 days, respectively. Perioperative courses were uneventful, and all the patients had immediate and complete relief of symptoms with mild compensatory sweating on the chest wall and the back. Even though a thoracoscopy has the possibility of emergency conversion to a thoracotomy and technical difficulties still exist, especially in patients with facial hyperhidrosis, our experience indicates that video-assisted thoracoscopic thoracic sympathectomy is a very safe and useful procedure for h perhidrosis.

• Journal of Chest Surgery
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• v.32 no.9
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• pp.813-817
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• 1999

Background: Conventional thoracoscopic thoracic sympathectomy or sympathicotomy is an effective method in treating localized hyperhidrosis; however, this may result in a postoperatively embarrassing compensatory hyperhidrosis or facial anhidrosis in the treatment of palmar hyperhidrosis. We modified the conventional sympathicotomy by limiting the extent of nerve transection. The purpose of this study was to assess the result of the limited thoracoscopic sympathetic nerve transection in hyperhidrosis. Material and Method: From May to August 1998, 17 patients underwent limited transection of the sympathetic nerve. For 9 patients with facial hyperhidrosis, we transected only the interganglionic fiber between the first and the second ganglion, whereas the conventional method cuts two interganglionic fibers. Eight patients with palmar hyperhidrosis underwent limited transection of the interganglionic fiber between the second and third ganglion. Result: Sixteen patients had improved symptom postoperatively. There was a recurred facial sweating in 1 patient 1 month after the operation. Among the 9 facial hyperhidrosis patients, postoperative compensatory hyperhidrosis was severe in 4, moderate in 4 and minimal in 1. But in 8 cases of palmar hyperhidrosis compensatory hyperhidrosis was moderate in 3, and minimal in 1, none in 4. Facial sweating was not disturbed postoperatively in all of the palmar hyperhidrosis patients. Conclusion: Limited sympathetic nerve transection is a practical and less invasive method for the treatment of localized hyperhidrosis and may reduce the incidence of compensatory truncal hyperhidrosis and facial anhidrosis in case of palmar hyperhidrosis.

• The Korean Journal of Pain
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• v.18 no.1
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• pp.89-91
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• 2005

Essential hyperhidrosis is a socially disabling and emotionally embarrassing condition. Localized excessive sweating in the sacrococcygeal region is a rare form of focal hyperhidrosis. Although numerous treatment options exist, including botulinum toxin and sympathetic neurolysis, there has been no generally accepted form of treatment. The following cases describe the successful reduction of excessive sweating in the sacrococcygeal region, without side effects, after local applications of topical glycopyrrolate and the use of fast drying clothes.

• Journal of Korean Neurosurgical Society
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• v.29 no.11
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• pp.1499-1504
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• 2000

Objectives : In general, conventional T2, T3 thoracoscopic sympathicotomy must be one of the most effective treatments for the essential palmar hyperhidrosis. However, this is offset by the occurrence of a high rate of side effects, such as embarrassing compensatory sweating and Hornor's syndrome. The authors have performed a selective T3 thoracoscopic sympathicotomy to our patients to see whether it provides successful results with less side effects. Its preliminary results were compared with those of conventional T2, T3 thoracoscopic sympathicotomy. Methods : The thoracoscopic sympathicotomy was performed in 54 patients suffering from essential palmar hyperhidrosis. Twenty-four patients underwent a conventional sympathicotmy(group A) from Jan 1997 to Dec 1997 and 30 patients a selective T3 sympathicotmy(group B) from Jan 1998 to Dec 1999. For assessment of postoperative success and of complications all patients charts were reviewed. Patients further received a postal questionnaire regarding long-term effect, satisfaction, and side-effects. Results : No recurrence was observed in both groups. The global rate of compensatory sweating was significantly(p ＝0.020) different in both groups : 11 patients(45.8%) in group A and 5 patients(16.73%) in group B. The Hornor's syndrome was observed only in 4 patients in group A. The preliminary results of the procedure in group A were considered fully-satisfying by 16 patients(66.6%), 6 patients(25%) were satisfied partially, and only 2 patients(8.3%) were dissatisfied, and those of the procedure in group B satisfying by 26 patients(86.6%), 4 patients(13.3.% ) were satisfied partially, and none dissatisfied. Conclusion : The selective T3 sympathicotomy results in a significant decrease in the rate of disturbing side effects comparing to conventional T2, T3 sympathicotomy and it dose not lead to recurrence. Our results contribute to recommendations of a selective T3 thoracoscopic sympathicotomy as treatment of choice in essential palmar hyperhidrosis.