Abstract

Palmar hyperhidrosis has been a troublesome medical problem for many asian youth causing much discomfort and inconvenience.

Aim: Hemorrhage during the procedure is a potential complication if the ganglion is traversed by a vessel. IT is difficult to dissect the vessel away from the ganglion as the operative field is limited. WE present one case report in which hemorrhage was controlled using Histoacryl injection at the bleeding site.

Methods: 28 years old male patient underwent needlescopic thoracic sympathectomy for palmar hyperhidrosis. During the procedure while coagulating 2^nd thoracic sympathetic ganglion, one vessel which was adherent to the ganglion started bleeding profusely which could not be controlled with usual diathermy. Histoacryl was injected into the bleeding site through 2mm port needle. The bleeding stopped instantaneously.

Results: The complications of this procedure are quite the same in all series published till now. Almost in one third of patients, the sympathetic chain is not clearly visible. Kao observed significant pleural adhesions and no reliable method of controlling haemorrhage. But with Injection Histoacryl the bleeding stopped immediately. The potential complication for which either a new port placement or conversion to open thoracotomy was required, was prevented by Histoacryl injection.

Conclusion: Histoacryl which was initially recommended for use in the closure of small and fresh skin wounds and later used extensively in Endoscopy rooms for bleeding duodenal/gastric ulcers can be safely used to stop the troublesome hemorrhage during needlescopic thoracic sympathectomy.

Keywords: Palmar hyperhidrosis, thoracic sympathectomy, histoacryl, hemorrhage