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Thoracoscopic sympathectomy using single port versus multiple ports as a treatment for palmar hyperhidrosis
magdi muhammad, abdulla allam.
king fahd hosp, Al madina Almunawara, Saudi Arabia.

OBJECTIVE: Hyperhidrosis can cause significant professional and social handicaps. Thoracic endoscopic sympathectomy has become the surgical technique of choice for treating intractable palmar hyperhidrosis. Endoscopic thoracic sympathectomy can be carried out through multiple ports or by using a single port. A prospective study was undertaken to compare outcomes between two methods.
METHODS: Between January 2008 and June 2012, 71 consecutive patients [30 male and 41 female; aged 22 ± 5.3 years] underwent video-assisted sympathectomy for palmar hyperhidrosis are included in this study. In all cases, the procedure was bilateral. The procedure was performed in one stage in all patients. All patients were seen 1 month and follow-up to one year after the operation. Patients were subdivided into 2 groups: Group A-35 patients underwent multiple ports video-assisted sympathectomy and Group B-36 patients underwent single port video-assisted sympathectomy. Preoperative, intraoperative and postoperative variables, morbidity, recurrence, and survival are compared in both groups.
RESULTS: Successful sympathectomies were performed in 100 % of the patients; the follow-up was from 1 to 12 months (mean 6 ± 3.4 months). There was no recurrence of palmar hyperhidrosis. No Horner's syndrome was reported. No mortality or serious postoperative complications. There was no conversion to an open procedure. Residual minimal pneumothorax occurred in two patients (5.7%) in group A and in one patient (2.8%) in group B. Minimal hemothorax occurred in one patient (2.9%) in group A and in three patients (8.3%) in group B. Compensatory hyperhidrosis encountered in seven patients (20%) in group A and in eight patients (22.2%) in group B.
CONCLUSIONS: No difference between bilateral multiple ports and single port video-assisted thoracoscopic sympathectomies and both are effective, safe and minimally invasive procedures improving permanently the quality of life in patients with palmar hyperhidrosis.

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