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Endoscopic transthoracic sympathectomy for idiopathic upper limb hyperhidrosis
1Department of Surgery, King's College Hospital, Denmark Hill, London, UK.
Summary
Endoscopic transthoracic sympathectomy effectively treats severe palmar hyperhidrosis, with 92% of patients experiencing improvement. While generally safe and simple, potential side effects like compensatory sweating and chest pain are manageable, making it a recommended surgical option.
Area of Science:
- Thoracic Surgery
- Neurosurgery
- Dermatology
Background:
- Idiopathic palmar hyperhidrosis significantly impacts quality of life.
- Surgical intervention is considered for cases unresponsive to conservative treatments.
Purpose of the Study:
- To evaluate the efficacy and safety of endoscopic transthoracic dorsal sympathectomy for idiopathic palmar hyperhidrosis.
- To assess patient satisfaction and outcomes following the procedure.
Main Methods:
- A 5-year retrospective review of 26 patients (51 procedures) undergoing sympathectomy.
- Ablation of the second, third, and fourth thoracic ganglia using diathermy cautery.
- Mean follow-up of 26 months.
Main Results:
- 92% of patients showed improvement or cure of hyperhidrosis.
- Axillary sweating was less effectively managed than palmar sweating.
- Common side effects included compensatory sweating (75%) and gustatory sweating (48%).
- Most patients reported satisfaction with functional and cosmetic outcomes.
Conclusions:
- Endoscopic transthoracic sympathectomy is an effective and relatively simple surgical treatment for palmar hyperhidrosis.
- The procedure offers a good functional and cosmetic outcome despite manageable side effects.
- It is recommended for upper limb hyperhidrosis refractory to conservative measures.