Palmo-Plantar Hyperhidrosis: Does Drainless One-port Thoracoscopic
Sympathectomy (DOTS) help?
Abstract
Objectives: Primary hyperhidrosis (PH) still impacts negatively the
patients’ quality of life (QoL). Progressively, it leads to poorer QoL
regardless of gender; finally, it ends up causing psycho-social and
professional embracement to patients. The thoracoscopic sympathectomy
(TS) has been used safely and effectively for control of palmar
hyperhidrosis; but it is still questionable in palmo-plantar type. We
assessed the benefits of drainless one-port thoracoscopic sympathectomy
(DOTS) in palmo-plantar and palmar hyperhidrosis. Methods: This
prospective study comprised 213 consecutive patients with PH who
underwent bilateral simultaneous DOTS. We used the Hyperhidrosis Disease
Severity Scale (HDSS) scoring system for assessment of quality of life
pre- and post-operatively. Follow up continued for one-year interval for
quality of life, recurrence, and compensatory hyperhidrosis. Results:
All patients experienced immediate complete resolution of hyperhidrosis
postoperatively. Recurrence encountered in one patient during first 6
months. All patients had improved quality of life postoperatively; but
at the end of 1-year follow up, 2.8 % of patients were still suffering
moderate to severe impaired QoL. Mean hospital stay was 31.79±17.5
hours. We found significant longer hospital stay in palmar group than
palmo-plantar group. There was no significant difference between both
groups in neither operative time, recurrence, nor compensatory
hyperhidrosis. Conclusions: DOTS offers better quality of life for
patients with primary hyperhidrosis even the palmo-plantar type. The
palmo-plantar type benefits similarly to the palmar type. In
palmo-plantar hyperhidrosis, we should rethink again about
post-operative plantar hyperhidrosis; it is accepted redistribution
compensatory hyperhidrosis rather than a miserable recurrence.