Abstract
Background Endoscopic thoracic sympathectomy has been accepted as the most effective treatment
for palmar hyperhidrosis (PH). However, there is a debate regarding the surgical techniques
in terms of effectiveness, recurrence, and reversibility. In this study, sympathetic
chain disruptions were compared in terms of whether the clipping or ablation technique
had an effect on the long-term outcomes of patients who underwent thoracic sympathectomy
for primary PH.
Patients and Methods All patients who underwent video-thoracoscopic sympathectomy for PH between May 2008
and October 2011 were included. Single-port bilateral sympathectomy was performed
depending on the sweat distribution. As a standard approach, rib-based terminology
was used to describe the blockade level of the sympathetic ganglia, and single-level
R3 sympathectomy (between R3 and R4) was performed in all patients. The type of sympathectomy
was changed. Monopolar electrocautery was first performed and 5-mm clips were then
used for nerve disruption. Both techniques were evaluated and compared in terms of
effectiveness, reversibility, and recurrence.
Results Cauterization of the sympathetic chain was applied in 28 (47%) (Group A) patients
and clipping in 32 (53%) patients (Group B). CH was the most common adverse effect
and was observed in 43 (71.6%) patients (Group A, 71.4%; Group B, 71.8%; p = 0.8). The success rate was 93% for Group A and 100% for Group B (p = 0.15). The satisfaction rate for Group A was 83% and for Group B was 86% (p = 0.77). In Group A two patients (7%), and in Group B three patients (9%) requested
reversibility because of severe compensatory hyperhidrosis. Overly dry hands were
the other most common side effect and were identified in 12 (25%) patients. Recurrences
were observed in 11 patients in Group A and 4 patients in Group B (19 vs. 6%; p = 0.01). The mean follow-up time was 33 ± 10.5 months (range, 13–53 months).
Conclusion Both clipping and cauterization are highly effective for the treatment of PH. The
methods are comparable in terms of effectiveness and side effects despite the fact
that the recurrence rate was higher in the cauterization group. Potential reversibility
of compensatory sweating was not observed in our series. Identification of ideal candidates
for surgery and education of patients about the permanent side effects of sympathectomy
might make these techniques more convenient.
Keywords
thoracoscopy/VATS - quality of life - hyperhidrosis
