Preserving T2 in thoracic sympathicotomy for palmar hyperhidrosis: less tissue trauma, same effectiveness

The aim of this study was to compare two different sympathicotomy procedures for primary hyperhidrosis in terms of compensatory sweating, complications, safety and effectiveness.

The data of 78 consecutive patients who underwent bilateral endoscopic thoracic sympathicotomy (156 laterals) for palmar hyperhidrosis between January 2005 and September 2009 were studied retrospectively. The first 29 consecutive patients were treated with a T2-3 sympathicotomy (Group A). After November 2007, all patients (49 patients) were treated with a T3 sympathicotomy alone (Group B). The chest tubes were always removed after checking for pneumothorax with roentgenography. All patients were followed up and evaluated for results, side effects, complications, and satisfaction levels. The differences between the two groups were analyzed.

The mean age of the 47 (60.2 %) female and 31 (39.8 %) male patients was 25.2 years. Horner's syndrome and pneumothorax was not detected in either group. The mean follow-up time was 20.82 months (6-52 months). Effectiveness of the procedure at the time of discharge and at follow-up was 100 % and 97.5 %, respectively. There was no significant difference between groups with regard to any analyzed parameter.

This study demonstrates that preserving the T2 ganglion is safe, and does not compromise the effectiveness of the procedure. Sympathicotomy has the same success rate as sympathectomy, but requires significantly less dissection and results in less tissue trauma.