Early experience with thoracoscopic sympathectomy for palmar hyperhidrosis

Excessive craniofacial, palmar and axillary hyperhidrosis can be very distressing in young people, especially in hot climates. In this study, we are presenting our operative experience and the long-term effect of the technique of thoracospic electrocoagulation of the thoracic sympathetic chain in the treatment of this condition. We reviewed the results of 22 thoracoscopies performed on 16 patients at Asir Central Hospital in Abha, Saudi Arabia during the period from January 1999 to December 2002. The patients were 11 males and five females with a mean age of 26.9+/-5 years (range 19-35 years). Except for one patient who presented with post-traumatic, left upper limb chronic regional pain syndrome (CRPS), the rest presented with craniofacial, palmar and axillary hyperhidrosis. In the first 10 patients, sympathectomy was performed unilaterally and in the following six patients it was performed bilaterally in the same sitting. While pneumothorax occurred in three patients (19%), only one patient (6%) required chest tube insertion. During the mean follow-up period of 25.6+/-14.2 months (range 4-47 months), only one patient (6%) presented with recurrent left axillary hyperhidrosis. The patient underwent another thoracoscopy which failed due to lung adhesions and required subcutaneous electrocautery of the sweat glands. In conclusion, thoracoscopic sympathectomy is very effective (94%) in the treatment of palmar and axillary hyperhidrosis with no mortality, minimal morbidity and durable long-term effect.