T4 sympathectomy for palmar hyperhidrosis: looking for the right operation

ABSTRACT

Most surgeons still perform T2 or T2-3 sympathectomy for palmar hyperhidrosis, but both these treatments can cause severe side effects. Some recent articles have advocated T4 sympathectomy and obtained satisfactory results. The aim of this study was to compare the outcomes of 3 different levels of sympathectomy. Between July 2003 and July 2006, we treated 60 patients [20 males and 40 females, mean age 26 years] suffering from palmar hyperhidrosis by Endoscopic thoracic sympathectomy [ETS]. Patients were randomized into three groups according to the level of sympathectomy, ETS2, ETS3 and ETS4 groups [20 patients in each group]. Data was collected by review of medical charts, outpatient clinic and telephone interviews. patients were asked to state whether they considered their symptoms to be cured', or unchanged'. The degree of hand dryness was assessed .Postoperative complications [including wound infection, chest pain, and Horner's syndrome] were assessed. Any occurrence of gustatory sweating, rhinitis, reflex [compensatory] sweating [CS], regions of CS and recurrence was noted. Patient satisfaction was assessed. Treatment success at follow-up was 90% for the ETS2, 95% for ETS3 patients and 100% for the ETS4 patients. In the ETS2 group and ETS3 group, a higher rate of over dryness of limbs was observed in 7 patients [35%], 4 patients [20%]; respectively. The reflex sweating was mild in the ETS4 group, while moderate and severe reflex sweating were more common in the ETS2and ETS3 group patients. Around 40% of ETS2 groups and 25% of ETS3 group patients were unsatisfied with their surgery. All patients of ETS4 group were satisfied with the outcome of surgery. In conclusion, ETS4 sympathectomy is an effective method for treating PH. The success rate is 100% and there is no recurrence. Most importantly, the rate of CS is reduced to a minimum