Interruzione del simpatico toracico mediante neurocompressione nel trattamento dell'iperidrosi primitiva: indicazioni e risultati ottenuti in 281 pazienti

Aim. Hyperhidrosis is a disabling troublesome characterized by excessive perspiration that produces a significant social and professional deficit for patients. It main involves the palmar sides of hands and feet, axillae, face and, with a lesser incidence, trunk and scalp. Thoracoscopic sympathectomy represents the best approach for this disorder. The aim of our prospective study is to assess the outcome, the safety and efficacy after thoracoscopic sympathetic block by clipping in the treatment of primary hyperhidrosis. Methods. Between september 2002 and april 2005, 281 patients (117 female and 164 male, with a mean age of 28 years) underwent Endoscopic Thoracic Sympathectomy (ETS) to treat hyperhidrosis with palmar, axillar, facial and widespread localization. Results. There were no deaths or major intraoperative problems. There was no conversion to open surgery. During intermediate and long-term follow up we obtained excellent results and few complications. In 3 patients (1.06%) we noted a major complication (Horner's Syndrome), but one patient only had the surgical operation reversed; compensatory sweating occurred in 61 individuals (21.7%). Gustatory sweating occurred in no patient. Conclusions. The clipping of the thoracic sympathetic chain is a reversible surgical technique considered safe and effective. Despite of an incidence of complications and/or compensatory sweating and according to our operatory results, we conclude that the sympathetic block by clamping is the elective treatment for hyperhidrosis.