VIDEOSCOPIC SYMPATHECTOMY IN HYPERHIDROSIS A safe and effective procedure - SYSTEMATIC REVIEW Introdução à Medicina II Turma 5 ano lectivo 2011/2012 turma5fmup1112@gmail.com

INDEX Results Introduction Discussion Methods Background Justification Index | Introduction | Methods | Results | Discussion INDEX Results Discussion Introduction Background Justification Aims Methods Our Systematic Review Query Inclusion step Results of Inclusion step Analysis

Index | Introduction | Methods | Results | Discussion Hyperhidrosis Condition characterized by dysfunctional sweating There are 2 types of hyperhidrosis: primary and secondary Focal Idiophatic .axillas .palms .soles .forehead HAIDER A., SOLISH N., 2005; VORKAMP, T., FOO F.J., KHAN S., SCHMITTO J. D., WILSON P., 2010

Treatment Modalities Affected population Consequences Index | Introduction | Methods | Results | Discussion Treatment Modalities Anticholinergics Intracutaneous injections of botulinum toxin Sweat gland removal surgical procedures (axillar hyperhidrosis) Iontophoresis Sympathectomy Affected population Affects 2,8 % of the general population Affects men and women equally Highest prevalence among aged 25-64 years 30-50% Genetic predisposition Consequences Decrease in health-related quality of life Psychological changes Social isolation (extreme cases) STRUTTON D.R., KOWALSKI J.W., GLASER D.A., STANG P.E., 2004; COHEN J.L., COHEN G., SOLISH N., MURRAY C.A. , 2007 HAIDER A., SOLISH N., 2005 COHEN J.L., COHEN G., SOLISH N., MURRAY C.A., 2007; HÖLZE E., 1984; WHITE J.W. Jr.,1986

INITIAL SEARCH THROUGH PUBMED Index | Introduction | Methods | Results | Discussion INITIAL SEARCH THROUGH PUBMED Articles about the most frequently used treatment for hyperhidrosis - ETS is the method more frequently used on hyperhidrosis treatment. Recent systematic reviews - “Primary hyperhidrosis. Current status of surgical treatment” in CIRUGÍA ESPAÑOLA, 2009 - “Thoracoscopic sympathectomy: a literature review” in NEUROCIRURGIA (Asturias, Spain), 2010

Failures of the two systematic reviews found JUSTIFICATION Index | Introduction | Methods | Results | Discussion Failures of the two systematic reviews found Results about quantity, type or quality of the articles are not presented They’re not very systematic

Index | Introduction | Methods | Results | Discussion Main Goal To understand if videoscopic sympathectomy is a good option for the treatment of hyperhidrosis, taking in account the results and complications of the surgery.

OUR SISTEMATIC REVIEW Index | Introduction | Methods | Results | Discussion The design of our systematic review involved a complex process with few steps. At first we had to define our problem and our goal. And then it was made a procedure in order select and analyze the articles.

Index | Introduction | Methods | Results | Discussion Start Define query Collect articles Creat groups of two people Divide all the articles Read title and abstract (each group) Does the article respect the inclusion criteria? Apply inclusion criteria Read full paper (each group) Obtain full paper Yes Apply inclusion criteria No Does the article have the relevant data for us to analyze? Exclude article No End Collect data (each group) Insert data into SPSS Analyse data Yes

Videoscopic Sympathectomy in Hyperidrosis – Results and complications Index | Introduction | Methods | Results | Discussion Defining the problem Videoscopic Sympathectomy in Hyperidrosis – Results and complications Articles collection (http://www.ncbi.nlm.nih.gov/pubmed/)

A specific query and selection criteria have been defined Index | Introduction | Methods | Results | Discussion A specific query and selection criteria have been defined Mesh terms  + Text words Query

QUERY Index | Introduction | Methods | Results | Discussion “hyperidrosis” [MeSH Terms] AND (“sympathectomy” [MeSH Terms] OR “sympathectomy” [Text Word]) “hyperidrosis” [MeSH Terms] AND (“sympathectomy” [MeSH Terms] OR “sympathectomy” [Text Word]) AND (”complications”[All Fields] OR results[All Fields] ) 816 articles 512 articles

FINAL QUERY “hyperidrosis” [MeSH Terms] AND Index | Introduction | Methods | Results | Discussion “hyperidrosis” [MeSH Terms] AND (“endoscopy” [MeSH Terms] OR endoscopic thorascopic [All Fields] OR videoscopic [All Fields] ) AND (“sympathectomy” [MeSH Terms] OR “sympathectomy” [Text Word]) AND (”complications”[All Fields] OR results[All Fields] ) 395 articles

Inclusion Criteria Written based on original data Index | Introduction | Methods | Results | Discussion Inclusion Criteria Written based on original data Written after Videoscopic Sympathectomy’s development Available using the UP credentials Written in English, Spanish or Portuguese

INCLUSION STEP Index | Introduction | Methods | Results | Discussion Fig. 1 – SPSS table used to apply inclusion criteria

INCLUSION STEP PUBMED Initial articles: 395 Index | Introduction | Methods | Results | Discussion PUBMED Initial articles: 395

Index | Introduction | Methods | Results | Discussion UP Credentials 39,7 %

Index | Introduction | Methods | Results | Discussion Original Data 8,4 % 91,6 %

Index | Introduction | Methods | Results | Discussion Language

RESULTS OF THE INCLUSION STEP Index | Introduction | Methods | Results | Discussion RESULTS OF THE INCLUSION STEP Included articles: 168 - 33 articles Cause: original data Initial articles: 395 Inclusion step - 158 articles Cause: UP credentials - 36 articles Cause: language

Year of Publication of the Included Articles Index | Introduction | Methods | Results | Discussion Year of Publication of the Included Articles

Index | Introduction | Methods | Results | Discussion Language 345 162 36 7 5 6 1 1

ANALYSIS Variables Type of study; Participant’s number; Age; Sex Index | Introduction | Methods | Results | Discussion Variables Type of study; Participant’s number; Age; Sex Satisfaction; Success; Life quality Mortality; Horner’s Syndrome; Compensatory Hyperhidrosis; Return of Hyperhidrosis; Hemothorax Location of the incisions; Number of incisions; Removal technique of sympathetic trunk

ANALYSIS TABLE Index | Introduction | Methods | Results | Discussion Fig. 2 – SPSS table used to analyse the articles

Initial articles to analyze: 168 After reading the whole paper of the included articles, we excluded 52 of them. The reason of that exclusion was, in most of the cases, the absence of data with interest for analysis. The total of articles analyzed were 116. Analyzed articles: 116

RESULTS Type of study n=116 Coorte= 41 Clinical trial= 47 Other= 28 Index | Introduction | Methods | Results | Discussion Type of study n=116 Coorte= 41 Clinical trial= 47 Other= 28

Number of participants Index | Introduction | Methods | Results | Discussion Number of participants n=113 Median= 90 Maximum= 2200 Minimum= 8

Mean Age n= 88 Median= 27,3 Maximum= 44 Minimum= 15,50 Index | Introduction | Methods | Results | Discussion Mean Age n= 88 Median= 27,3 Maximum= 44 Minimum= 15,50

Gender of participants Index | Introduction | Methods | Results | Discussion Gender of participants n=111

Previous complementary treatment Index | Introduction | Methods | Results | Discussion Previous complementary treatment n=111

Satisfaction n= 54 Median= 88,3% Maximum= 100% Minimum= 0% Index | Introduction | Methods | Results | Discussion Satisfaction n= 54 Median= 88,3% Maximum= 100% Minimum= 0%

Success n= 35 Median= 95% Maximum= 100% Minimum= 2,40% Index | Introduction | Methods | Results | Discussion Success n= 35 Median= 95% Maximum= 100% Minimum= 2,40%

Index | Introduction | Methods | Results | Discussion Quality of life This topic was not mentioned in all the analyzed articles, but those who reported it (16 articles), referred that there was always an improvement in the quality of life of people who underwent videoscopic thoracic sympathectomy.

Horner's syndrome COMPLICATIONS n= 35 Median= 1% Maximum: 10% Index | Introduction | Methods | Results | Discussion COMPLICATIONS Horner's syndrome n= 35 Median= 1% Maximum: 10% Minimum: 0%

Return of hyperhidrosis Index | Introduction | Methods | Results | Discussion Return of hyperhidrosis n= 39 Median= 5% Maximum= 70% Minimum= 0%

Compensatory hyperhidrosis Index | Introduction | Methods | Results | Discussion Compensatory hyperhidrosis n= 78 Median= 69,45% Maximum= 100% Minimum= 0%

Hemothorax n= 21 Median= 1,30% Maximum= 25% Minimum= 0% Index | Introduction | Methods | Results | Discussion Hemothorax n= 21 Median= 1,30% Maximum= 25% Minimum= 0%

Other complications n=116 Index | Introduction | Methods | Results | Discussion Other complications n=116

Index | Introduction | Methods | Results | Discussion Number of incisions n= 82

Index | Introduction | Methods | Results | Discussion Section level

No reference in the article Index | Introduction | Methods | Results | Discussion Surgical technique Frequency Percent Valid Percent Section 41 35,3% 57,7% Burn 19 16,4% 26,8% Both 11 9,5% 15,5% No reference in the article 45 38,8% - Total 116 100% Surgical technique

DISCUSSION Index | Introduction | Methods | Results | Discussion Despite frequent complications the levels of success, satisfaction, and quality of life are high, so it shows that it can be a good option of treatment for people who suffer of hyperhidrosis. The most frequent complications are return of hyperhidrosis and compensatory hyperhidrosis.

The main goal we had established was achieved. Index | Introduction | Methods | Results | Discussion In order to get better results in videoscopic sympathectomy it could be carried out an investigation in order to find out the reason of the great frequency of compensatory hyperhidrosis. The next step would be try to reduce the compensatory hyperhidrosis in this kind of surgery. The main goal we had established was achieved.