الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Primary hyperhidrosis is a non-common pathological condition of excessive sweating beyond that required to cool the body. It apparently originates from some poorly understood stimulation of sympathetic nervous system. It occurs in about 2% of the world population and it seems to have a genetic predisposition
It affects males and females equally, mainly in adolescence, with an underestimated incidence due to the feeling of shame and guilt of patients. This pathology has important implications in the life of the subjects who are affected, sometimes causing problems in relationship and in social life.
Primary hyperhidrosis could be treated by different treatment modalities. Medical treatment could be achieved by using topical therapies, oral therapies and injectable therapies. Topical therapies include antiperspirants and topical glycopyrrolate 2% while oral therapies include oral anticholinergics as oxybutinin and bornaprine. Injectable therapy could be achieved by the administration of the botulinum toxin at the sites of hyperhidrosis. However, surgery appears to be the best strategy considering the limited invasiveness of modern techniques. The excision of sympathetic chain and ganglia via the interruption of sympathetic trunk through sympathectomy at various levels based on the sweaty areas and the positioning of titanium clips along the chain are the most used methods.
The aim of the present study was to evaluate the efficiency, safety and advantages, disadvantages of video-assisted thoracoscopic sympathectomy versus video-assisted thoracoscopic sympathetic chain clipping in management of primary palmar hyperhidrosis.
This prospective and randomized clinical study involved a total of 30 eligible consecutive patients suffering from primary palmar hyperhidrosis treated by bilateral, bi-portal and tubeless thoracoscopic approach under general anesthesia. Fifteen patients were preforming Cutting of the sympathetic chain (group A) and the other 15 patients were applying endo-clips over the sympathetic chain (group B).
All patients had bilateral hyperhidrosis, 26.7 % had only palmar hyperhidrosis and 73.3% had combined hyperhidrosis (palmar plus either axillary or plantar or both).
The analysis of the intraoperative complications revealed only one patient (6.7%) in the ETS group who had an intraoperative bleeding due to injury of intercostal vessels by the diathermy during cutting the sympathetic chain that needed to be converted to thoracotomy (6.7%) as on table emergency to control the bleeding. This patient later on developed superficial wound infection (6.7%). In ETS group, 4 patients (26.6%) needed chest tube insertion intraoperatively instead of tubeless operation, which was significant compared to ESB. One patient of them had a tube due to conversion to open thoracotomy on one side. The other 3 patients were due to diathermy effect on the lung causing minor air leak that needed intraoperative chest drain and lasted for 24 hours with follow up chest X-ray. No patient in both groups developed Horner syndrome.
In ETS group, all patients 15 (100%) showed significant dryness of the hands and axillae on spot while only 1 (6.67%) patient in ESB group showed complete dryness within the first 24 hours. In ESB group, 12 (80%) patients showed nearly dry hand and axillae and 2 (13.33%) patients showed wet hand