VIDEOSCOPIC SYMPATHECTOMY IN HYPERHIDROSIS
A safe and effective procedure - SYSTEMATIC REVIEW
Introdução à Medicina II
Turma 5 ano lectivo 2011/2012
[email protected]
Index | Introduction | Methods | Results | Discussion
INDEX
 Introduction
 Results
Background
Justification
 Discussion
Aims
 Methods
Our Systematic Review
Query
Inclusion step
Results of Inclusion step
2
Analysis
Index | Introduction | Methods | Results | Discussion
INTRODUCTION
Hyperhidrosis
Condition characterized by dysfunctional sweating
There are 2 types of hyperhidrosis: primary and secondary
Focal
Idiophatic
HAIDER A., SOLISH N., 2005; VORKAMP, T., FOO F.J., KHAN S., SCHMITTO J. D., WILSON P., 2010
3
.axillas
.palms
.soles
.forehead
Index | Introduction | Methods | Results | Discussion
AFFECTED POPULATION
Affects 2,8 % of the
general population
Affects men and women
equally
Highest prevalence
among aged 25-64 years
CONSEQUENCES
Decrease in
health-related
quality of life
Psychological
changes
Social isolation
TREATMENT
MODALITIES
Anticholinergics
Intracutaneous
injections of
botulinum toxin
Sweat gland removal
surgical procedures
(axillar hyperhidrosis)
(extreme cases)
Iontophoresis
30-50%
Genetic predisposition
Sympathectomy
COHEN J.L., COHEN G., SOLISH N., MURRAY C.A., 2007; HÖLZE E., 1984; WHITE J.W. Jr.,1986
4
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
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
5
- “Thoracoscopic sympathectomy: a literature review” in NEUROCIRURGIA (Asturias, Spain), 2010
Index | Introduction | Methods | Results | Discussion
JUSTIFICATION
Failures of the two systematic reviews found
Results about quantity, type or
quality of the articles are not
presented
6
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
7
account the results and complications of the surgery.
Index | Introduction | Methods | Results | Discussion
OUR SISTEMATIC REVIEW
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
8
the articles.
Index | Introduction | Methods | Results | Discussion
Start
Read full paper
(each group)
Obtain full
paper
Yes
Divide all the
articles
Does the
article respect
the inclusion
criteria?
Apply inclusion
criteria
Apply
inclusion
criteria
No
Does the
article have
the relevant
data for us to
analyze?
Yes
Read title and
abstract
(each group)
No
Collect data
(each
group)
Exclude article
Insert data
into SPSS
Analyse data
End
9
Define query
Creat
groups of
two people
Collect
articles
Index | Introduction | Methods | Results | Discussion
Defining the problem
Videoscopic Sympathectomy in Hyperidrosis – Results and
complications
Articles collection
10
(http://www.ncbi.nlm.nih.gov/pubmed/)
Index | Introduction | Methods | Results | Discussion
A specific query and selection criteria have been defined
Mesh terms
+
Text words
11
Query
Index | Introduction | Methods | Results | Discussion
QUERY
• “hyperidrosis” [MeSH Terms] AND (“sympathectomy” [MeSH Terms]
OR “sympathectomy” [Text Word])
816 articles
• “hyperidrosis” [MeSH Terms] AND (“sympathectomy” [MeSH Terms]
OR “sympathectomy” [Text Word]) AND (”complications”[All Fields]
OR results[All Fields] )
12
512 articles
Index | Introduction | Methods | Results | Discussion
FINAL QUERY
• “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] )
13
395 articles
Index | Introduction | Methods | Results | Discussion
Inclusion Criteria
Written based on original data
Written after Videoscopic Sympathectomy’s development
Available using the UP credentials
14
Written in English, Spanish or Portuguese
Index | Introduction | Methods | Results | Discussion
INCLUSION STEP
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Fig. 1 – SPSS table
used to apply
inclusion criteria
Index | Introduction | Methods | Results | Discussion
INCLUSION STEP
PUBMED
16
Initial articles: 395
Index | Introduction | Methods | Results | Discussion
UP Credentials
39,7 %
Yes
No
17
60,3 %
Index | Introduction | Methods | Results | Discussion
Original Data
8,4 %
Yes
No
18
91,6 %
Index | Introduction | Methods | Results | Discussion
Language
English
Portuguese
Spanish
French
19
Others
Index | Introduction | Methods | Results | Discussion
RESULTS OF THE INCLUSION STEP
Initial articles: 395
Cause: original data
- 36 articles
Cause: language
I
n
c
l
u
s
i
o
n
s
t
e
p
- 158 articles
Cause: UP credentials
Included articles: 168
20
- 33 articles
Index | Introduction | Methods | Results | Discussion
Year of Publication of the Included Articles
25
20
15
10
5
21
1986
1990
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
Index | Introduction | Methods | Results | Discussion
Language
345
162
36
English
0
Portuguese
7
5
Spanish
6
1
French
0
Others
22
1
Index | Introduction | Methods | Results | Discussion
ANALYSIS
Variables
Participant’s number;
Satisfaction;
Mortality;
Hyperhidrosis;
Success;
Sex
Life quality
Horner’s Syndrome;
Compensatory
Return of Hyperhidrosis;
Location of the incisions;
Age;
Hemothorax
Number of incisions;
Removal technique of sympathetic trunk
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Type of study;
Index | Introduction | Methods | Results | Discussion
ANALYSIS TABLE
24
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.
25
Analyzed articles: 116
Index | Introduction | Methods | Results | Discussion
RESULTS
Type of study
n=116
Coorte= 41
Clinical trial= 47
26
Other= 28
Index | Introduction | Methods | Results | Discussion
Number of participants
n=113
Median= 90
Maximum= 2200
27
Minimum= 8
Index | Introduction | Methods | Results | Discussion
Mean Age
n= 88
Median= 27,3
Maximum= 44
28
Minimum= 15,50
Index | Introduction | Methods | Results | Discussion
Gender of participants
29
n=111
Index | Introduction | Methods | Results | Discussion
Previous complementary treatment
30
n=111
Index | Introduction | Methods | Results | Discussion
Satisfaction
n= 54
Median= 88,3%
Maximum= 100%
31
Minimum= 0%
Index | Introduction | Methods | Results | Discussion
Success
n= 35
Median= 95%
Maximum= 100%
32
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
33
underwent videoscopic thoracic sympathectomy.
Index | Introduction | Methods | Results | Discussion
COMPLICATIONS
Horner's syndrome
n= 35
Median= 1%
Maximum: 10%
34
Minimum: 0%
Index | Introduction | Methods | Results | Discussion
Return of hyperhidrosis
n= 39
Median= 5%
Maximum= 70%
35
Minimum= 0%
Index | Introduction | Methods | Results | Discussion
Compensatory hyperhidrosis
n= 78
Median= 69,45%
Maximum= 100%
36
Minimum= 0%
Index | Introduction | Methods | Results | Discussion
Hemothorax
n= 21
Median= 1,30%
Maximum= 25%
37
Minimum= 0%
Index | Introduction | Methods | Results | Discussion
Other complications
38
n=116
Index | Introduction | Methods | Results | Discussion
Number of incisions
39
n= 82
Index | Introduction | Methods | Results | Discussion
40
Section level
Index | Introduction | Methods | Results | Discussion
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%
100%
Surgical
technique
41
Surgical technique
Index | Introduction | Methods | Results | Discussion
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
42
hyperhidrosis and compensatory hyperhidrosis.
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.
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The main goal we had established was achieved.