Skip to main content
Log in

Long-term results of endoscopic symphathetic block using the Lin-Telaranta classification

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Endoscopic thoracic sympathectomy has been used successfully in the treatment of blushing, excessive sweating, and social phobia. However, the adverse effects of endoscopic thoracic sympathectomy are more severe and frequent than the adverse effects of endoscopic sympathetic block (ESB). The use of different blocking levels for different indications in ESB according to the Lin-Telaranta classification further decreases the postoperative adverse effects. However, there are few data on the long-term results of ESB performed using the Lin-Telaranta classification.

Methods

Ninety-five patients (55 men, 40 women) were interviewed by before the surgery using our routine questionnaire, and the same questionnaire was answered postoperatively by the patients. In addition, a long-term follow-up questionnaire was sent to all patients whose address was known. Forty-seven patients (24 men, 23 women) answered to this questionnaire. The Davidson brief social phobia scale and the Liebowitz quality of life scale were used. Patients were divided to 3 categories: category 1, patients with sweating problems; category 2, patients with blushing; and category 3, and patients with symptoms other than sweating or blushing.

Results

Among patients in category 1, social phobia decreased from 12.43 to 6.71 (p = 0.004), in category 2 from 13.97 to 7.69 (p < 0.001), and in category 3 from 13.18 to 9.64 (p = 0.007) during long-term follow-up. Among patients with severe sweating problems preoperatively, sweating decreased from 2.50 to 1.29 (p = 0.003) among patients in category 1 and from 1.86 to 1.16 (p < 0.001) among patients in category 2. Among patients with unbearable blushing, blushing decreased from 4 to 1.80 (p < 0.001).

Conclusions

Patients got a clear help from ESB performed using the Lin-Telaranta classification to treat blushing, excessive sweating, and social phobia with and without physical symptoms. In addition, compensatory sweating increased only slightly.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Coveliers H, Atif S, Rauwerda J, Wisselink W (2011) Endoscopic thoracic sympathectomy: long-term results for treatment of upper limb hyperhidrosis and facial blushing. Acta Chir Belg 111:293–297

    PubMed  CAS  Google Scholar 

  2. Smidfelt K, Drott C (2011) Late results of endoscopic thoracic sympathectomy for hyperhidrosis and facial blushing. Br J Surg 98:1719–1724

    Article  PubMed  CAS  Google Scholar 

  3. Telaranta T (1998) Treatment of social phobia by endoscopic thoracic sympathicotomy. Eur J Surg Suppl 580:27–32

    PubMed  Google Scholar 

  4. Zacherl J, Huber ER, Imhof M, Plas EG, Herbst F, Függer R (1998) Long-term results of 630 thoracoscopic sympathicotomies for primary hyperhidrosis: the Vienna experience. Eur J Surg Suppl 580:43–46

    PubMed  Google Scholar 

  5. Jadresic E, Súarez C, Palacios E, Palacios F, Matus P (2011) Evaluating the efficacy of endoscopic thoracic sympathectomy for generalized social anxiety disorder with blushing complaints: a comparison with Sertraline and no treatment—Santiago de Chile, 2003–2009. Innov Clin Neurosci 8:24–35

    PubMed  Google Scholar 

  6. Gossot D, Galetta D, Pascal A, Debrosse D, Caliandro R, Girard P, Stern J, Grunenwald D (2003) Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis. Ann Thorac Surg 75:1075–1079

    Article  PubMed  Google Scholar 

  7. Dumont P, Denoyer A, Robin P (2004) Long-term results of thoracoscopic sympathectomy for hyperhidrosis. Ann Thorac Surg 78:1801–1807

    Article  PubMed  Google Scholar 

  8. Licht P, Ladegaard L, Pilegaard H (2006) Thoracoscopic sympathectomy for isolated facial blushing. Ann Thorac Surg 81:1863–1866

    Article  PubMed  Google Scholar 

  9. Libson S, Kirstein B, Mizrahi S, Lantsberg L (2007) Evaluation of compensatory sweating after bilateral thoracoscopic sympathectomy for palmar hyperhidrosis. Surg Laparosc Endosc Percutan Tech 17:511–513

    Article  PubMed  Google Scholar 

  10. Bachmann K, Standl N, Kaifi J, Busch P, Winkler E, Mann O, Izbicki J, Strate T (2009) Thoracoscopic sympathectomy for palmar and axillary hyperhidrosis: four-year outcome and quality of life after bilateral 5-mm dual port approach. Surg Endosc 23:1587–1593

    Article  PubMed  Google Scholar 

  11. Lin CC, Mo LR, Lee LS, Ng SM, Hwang MH (1998) Thoracoscopic T2-sympathetic block by clipping—a better and reversible operation for treatment of hyperhidrosis palmaris: experience with 326 cases. Eur J Surg Suppl 580:13–16

    PubMed  Google Scholar 

  12. Pohjavaara P, Telaranta T (2005) Endoscopic sympathetic block as treatment of social phobia. Eur Surg 37:137–142

    Article  Google Scholar 

  13. Pohjavaara P, Telaranta T, Väisänen E (2001) Endoscopic sympathetic block—new treatment of choice for social phobia? Ann Chir Gynaecol 90:177–184

    PubMed  CAS  Google Scholar 

  14. Sugimura H, Spratt E, Compeau C, Kattail D, Shargall Y (2009) Thoracoscopic sympathetic clipping for hyperhidrosis: long-term results and reversibility. J Thorac Cardiovasc Surg 137:1370–1376

    Article  PubMed  Google Scholar 

  15. Whitson B, Andrade R, Dahlberg P, Maddaus M (2007) Evolution of clipping for thoracoscopic sympathectomy in symptomatic hyperhidrosis. Surg Laparosc Endosc Percutan Tech 17:287–290

    Article  PubMed  Google Scholar 

  16. Coelho Mde S, Silva RF, Mezzalira G, Bergonse Neto N, Stori Wde S Jr, dos Santos AF, El Haje S (2009) T3–T4 endoscopic sympathetic blockade versus T3T4 video thoracoscopic sympathectomy in the treatment of axillary hyperhidrosis. Ann Thorac Surg 88:1780–1785

    Article  PubMed  Google Scholar 

  17. Yanagihara T, Ibrahimiye A, Harris C, Hirsch J, Gorenstein L (2010) Analysis of clamping versus cutting of T3 sympathetic nerve for severe palmar hyperhidrosis. J Thorac Cardiovasc Surg 140:984–989

    Article  PubMed  Google Scholar 

  18. Neumayer C, Zacherl J, Holak G, Függer R, Jakesz R, Herbst F, Bischof G (2004) Limited endoscopic thoracic sympathetic block for hyperhidrosis of the upper limb: reduction of compensatory sweating by clipping T4. Surg Endosc 18:152–156

    Article  PubMed  CAS  Google Scholar 

  19. Reisfield R (2006) Sympathectomy for hyperhidrosis: should we place the clamps at T2–T3 or T3–T4? Clin Auton Res 16:384–389

    Article  Google Scholar 

  20. Schmidt J, Bechara F, Altmeyer P, Zirngibl H (2006) Endoscopic thoracic sympathectomy for severe hyperhidrosis: impact of restrictive denervation on compensatory sweating. Ann Thorac Surg 81:1048–1055

    Article  PubMed  Google Scholar 

  21. Li X, Tu Y, Lin M, Lai F, Chen J, Dai Z (2008) Endoscopic thoracic sympathectomy for palmar hyperhidrosis: a randomized control trial comparing T3 and T2–4 ablation. Ann Thorac Surg 85:1747–1751

    Article  PubMed  Google Scholar 

  22. Lin CC, Telaranta T (2001) Lin-Telaranta classification: the importance of different procedures for different indications in sympathetic surgery. Ann Chir Gynaecol 90:161–166

    PubMed  CAS  Google Scholar 

  23. Davidson JR, Miner CM, De Veaugh-Geiss J, Tupler LA, Colket JT, Potts NL (1997) The brief social phobia scale: a psychometric evaluation. Psychol Med 27:161–166

    Article  PubMed  CAS  Google Scholar 

  24. Taiminen T (1998) Sosiaalisten tilanteiden pelon hoito. Duodecim 114:73–79

    PubMed  CAS  Google Scholar 

  25. American Psychiatric Association (2000) Diagnostic statistical manual of mental disorders. DSM-IV-TR, 4th edn. American Psychiatric Press, Washington

    Google Scholar 

  26. Malmivaara A, Kuukasjärvi P, Autti-Rämö I, Kovanen N, Mäkelä M (2007) Effectiveness and safety of endoscopic thoracic sympathectomy for excessive sweating and facial blushing: a systematic review. Int J Technol Assess Health Care 23:54–62

    Article  PubMed  Google Scholar 

  27. Connor KM, Davidson JRT, Chung H, Yang R, Clary CM (2006) Multidimensional effects of sertraline in social anxiety disorder. Depress Anxiety 23:6–10

    Article  PubMed  CAS  Google Scholar 

  28. Hasmonai M, Assalia A, Kopelman D (2001) Thoracoscopic sympathectomy for palmar hyperhidrosis. Ablate or resect? Surg Endosc 15:435–441

    Article  Google Scholar 

  29. Currie A, Evans J, Thomas P (2011) An analysis of the natural course of compensatory sweating following thoracoscopic sympathectomy. Int J Surg 9:437–439

    Article  PubMed  CAS  Google Scholar 

  30. Cerfolio R, De Campos J, Bryant C, Miller D, DeCamp M, McKenna R, Krasna M (2011) The society of thoracic surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg 91:1642–1648

    Article  PubMed  Google Scholar 

  31. Candas F, Gorur R, Haholu A, Yiyit N, Yildizhan A, Gezer S, Sen H, Isitmangil T (2012) The effects of clipping on thoracic sympathetic nerve in rabbits: early and late histopathological findings. Thorac Cardiovasc Surg 60:280–284

    Article  PubMed  Google Scholar 

  32. Loscertales J, Congregado M, Jimenez-Merchan R, Gallardo G, Trivino A, Moreno S, Loscertales B, Galera-Ruiz H (2012) Sympathetic chain clipping for hyperhidrosis is not a reversible procedure. Surg Endosc 26:1258–1263

    Article  PubMed  Google Scholar 

Download references

Disclosures

Tuomo Rantanen and Timo Telaranta have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tuomo Rantanen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rantanen, T., Telaranta, T. Long-term results of endoscopic symphathetic block using the Lin-Telaranta classification. Surg Endosc 27, 3860–3864 (2013). https://doi.org/10.1007/s00464-013-2995-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-013-2995-3

Keywords

Navigation