A prospective controlled randomized multicenter study to evaluate the severity of compensatory sweating after one-stage bilateral thoracic sympathectomy versus unilateral thoracic sympathectomy in the dominant side

• Main Authors: Niura Noro Hamilton, Miguel Lia Tedde, Nelson Wolosker, Wolfgang William Schmidt Aguiar, Hylas Paiva da Costa Ferreira, Humberto Alves de Oliveira, Alexandre Marcelo Rodrigues Lima, Fernando Luiz Westphal, Marina Varela Braga de Oliveira, Fabio de Oliveira Riuto, Sergio Tadeu Lima F Pereira, Guilherme Cançado Rezende, Caroline Elizabeth Brero Valero, Paulo M. Pego-Fernandes
• Format: Article
• Language: English
• Published: Elsevier 2020-09-01
• Series: Contemporary Clinical Trials Communications
• Subjects: Hyperhidrosis; Sweating; Sympathectomy; Compensatory sweating; Thoracic surgery; Video-Assisted
• Online Access: http://www.sciencedirect.com/science/article/pii/S2451865420301022

Objective: To evaluate the contribution that unilateral thoracic sympathectomy in dominant side or two-stage bilateral thoracic sympathectomy can have as strategies to reduce the incidence of compensatory sweating after sympathectomy for palmar hyperhidrosis. Methods: This is a prospective, controlled, randomized multicenter trial of 200 participants with palmar hyperhidrosis, which will be randomized into two arms: (a) one-stage bilateral thoracic sympathectomy (control arm); or (b) unilateral thoracic sympathectomy in dominant side (intervention arm). At six months the participants submitted to unilateral procedure can make the contralateral surgery if they wanted it, creating a third group called two-stage bilateral sympathectomy. Participants will be evaluated for the degree of sweating by the Hyperhidrosis Disease Severity Scale (HDSS) and of quality of life questionnaires. Results: 96 participants out of the 200 proposed have been included so far, with 48 participants randomized to each arm. From the sample 61 (63.5%) are female, with a mean age of 24 (20–32) years. There were exclusive palmar hiperhydrosis in 14 cases (14.5%), palmar and plantar hyperhidrosis in 36 (37.5%) cases, palmar and axillar hyperhidrosis in 12 (12,5%) cases and palmar-axillary-plantar hyperhidrosis in 34 (35,4%) cases. The age at the beginning of the disease was childhood (78%), with mean of time of disease 15 (11–22) years. Conclusions: If one or both hypothesis: (a) unilateral sympathectomy in dominant hand is a satisfactory treatment; b) two-stage bilateral sympathectomy causes less compensatory sweating than in one stage are confirmed there is a chance that surgical therapy for palmar hyperhidrosis can be changed for better.