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

2. 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

3. 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

4. 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 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

5. 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

6. 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

7. 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.

8. 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.

9. 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

10. Videoscopic Sympathectomy in Hyperidrosis – Results and complications
Index | Introduction | Methods | Results | Discussion
Defining the problem
Videoscopic Sympathectomy in Hyperidrosis – Results and complications
Articles collection (

11. 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

12. 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

13. 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

14. 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

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

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

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

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

19. Index | Introduction | Methods | Results | Discussion
Language

20. 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

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

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

23. 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

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

25. 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

26. 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

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

28. 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

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

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

31. 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%

32. 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%

33. 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.

34. 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%

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

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

37. 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%

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

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

40. Index | Introduction | Methods | Results | Discussion
Section level

41. 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

42. 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.

43. 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.