Thoracoscopic sympathectomy for palmar hyperhidrosis

Abstract

Primary palmar hyperhidrosis is a pathological condition of overperspiration, which affects a substantial number of the young population all over the world. Surgical upper dorsal sympathectomy achieves excellent long-term results. The thoracoscopic approach has supplanted the open procedures. During a period of 3V4 years (June 1993 to December 1996) we have performed 232 thoracoscopic upper dorsal (T2-T3) sympathectomy on 116 patients ranging in age from 14 to 49 years, (mean 23.5 ±7.2 years) were studied. Both sides were operated during the same surgical procedure. The T2-T3 ganglia were resected by electrocauting with a hook and were removed for histological examination. Follow-up for a mean of 25.04 ±12.82 months was obtained on 108 patients (216 operated limbs). All limbs were completely dry at the end of the procedure, and hyperhidrosis did not recur during the follow-up period, apart for mild sweating of one hand of a female patient during hot weather. Short term postoperative complications (mainly atelectasis, pneumonia, pneumothorax and haemothorax) occurred in fifteen (12.9%) patients. Longterm sequelae were observed in 84 (77/8%) patients and included Horner's syndrome [10 patients (9.3%)] one eye in each patient; neuralgia [11 patients (10.2%)]; compensatory hyperhidrosis [56 patients (51.6%]. These sequelae were not permanent in all cases, and the degree of severity was variable. Eight (7.4%) of patients, three of whom (2.8%) regretted being operated, were dissatisfied with their results: one because of Horner's syndrome, one because of persisting neuralgia, and six because of compensatory hyperhidrosis. The complication rate in the second half period of the present study was substantially reduced in comparison to the first cases. Despite the large number of postoperative long-term sequelae, 92.6% of patients expressed subjective satisfaction from the procedure. Obtaining practically 100% dry hands on two years mean follow-up make this approach rewarding. ©1998 Scandinavian University Press.