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Can You Predict Who Will Get Severe Compensatory Sweating Before ETS ?

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 28, 2008

Severe Compensatory Sweating Can Be Predicted with Endoscopic Thoracic Sympathetic Block

Dr. Daniel Miller from the ASection of General Thoracic Surgery, Department of General Surgery, Emory University School of Medicine, Atlanta, Georgia has reported an interesting study in the Annals of Thoracic Surgery (April 2008) regarding compensatory sweating following Endoscopic Thoracic Sympathectomy (ETS).

Dr. Miller states that the “fear of compensatory hyperhidrosis is the most common reason why patients do not undergo a sympathectomy, because it is an irreversible procedure unless removal clips are used. Unfortunately, clip removal for reversal of postsympathectomy compensatory hyperhidrosis has not been reliable”.

To address this issue, Dr. Miller has performed temporary thoracoscopic sympathetic block to predict if postsympathectomy compensatory hyperhidrosis is going to occur after Sympathectomy.

All patients enrolled in his study were concerned about the development of compensatory sweating and requested the possibility of a reversible procedure
Sympathetic blockade was performed at each level of the planned sympathectomy (T2, T3, and accessory nerves) with 2.5 cc 0.25% marcaine with epinephrine per level without complications. All patients had temporary relief of hyperhidrosis ranging from 1 to 10 days with a median of 4 days after the block.
12% had temporary compensatory sweating after the thoracoscopic block, 2 mild and 1 severe. All but 1 (4%) patient who had severe compensatory sweating elected to proceed with the planned Sympathectomy.
Dr. Miller concluded that “temporary thoracoscopic sympathetic block is a reversible and accurate procedure for the determination of postsympathectomy compensatory sweating. Temporary thoracoscopic sympathetic block followed by sympathectomy may be the best approach for the treatment of medically refractory primary hyperhidrosis in patients who are concerned about the development of postsympathectomy compensatory sweating.

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For more information about hyperhidrosis (excessive sweating) , as well as surgical and non-surgical hyperhidrosis treatment options, contact Dr. Karamanoukian at The Center for Excessive Sweating, a National Center of Excellence for Hyperhidrosis Treatment by email or by phone at (716) 839-3638.

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