Reoperative endoscopic sympathectomy for persistent or recurrent palmar hyperhidrosis.

Area of Science:

• Thoracic surgery
• Neurosurgery
• Dermatology

Background:

• Sympathectomy is a treatment for severe palmar hyperhidrosis.
• Some patients experience persistent or recurrent hyperhidrosis after initial sympathectomy.

Purpose of the Study:

• To review the experience with reoperative thoracoscopic sympathectomy (RS) for palmar hyperhidrosis.
• To compare the outcomes of RS with initial thoracoscopic sympathectomy (TS).

Main Methods:

• Retrospective analysis of patients undergoing RS for palmar hyperhidrosis.
• Comparison with patients undergoing initial TS during the same period.
• Analysis of previous sympathectomy methods, operative complications, and outcomes.

Main Results:

• RS provided comparable alleviation of palmar hyperhidrosis to TS (38/40 vs. 316/321).
• RS was associated with increased pleural adhesions, need for pleural drainage, and longer hospital stay.
• Higher rates of compensatory sweating were observed in the RS group (21/40 vs. 101/321).

Conclusions:

• Reoperative thoracoscopic sympathectomy is a safe and effective option for severe palmar hyperhidrosis refractory to initial sympathectomy.
• RS yields comparable symptom improvement but with increased operative difficulty and side effects.
• Careful patient selection is essential for reoperative sympathectomy.