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Thoracoscopic sympathicotomy for disabling palmar hyperhidrosis: a prospective randomized comparison between two
Fritz J Baumgartner1, Maria Reyes, Grant G Sarkisyan
1Doctors Outpatient Surgery Center, Fountain Valley, California, USA. f.baumgartner@earthlink.net
The Annals of Thoracic Surgery
|November 26, 2011
Summary
Thoracoscopic sympathicotomy effectively treats palmar hyperhidrosis. While both R2 and R3 levels show high success, R2 may have slightly more compensatory sweating (CH), and R3 has a higher risk of dramatic recurrence.
Area of Science:
- Thoracic surgery
- Neurosurgery
- Dermatology
Background:
- Thoracoscopic sympathicotomy is a primary treatment for severe palmar hyperhidrosis.
- Optimal surgical level for sympathicotomy remains debated to balance efficacy and compensatory sweating (CH).
Purpose of the Study:
- To compare the efficacy and side effect profiles of sympathicotomy at the second (R2) versus third (R3) costal levels for massive palmar hyperhidrosis.
Main Methods:
- A prospective, randomized study involving 121 patients with disabling palmoplantar hyperhidrosis.
- Patients underwent bilateral sympathicotomy at either R2 (61 patients) or R3 (60 patients).
- Outcomes including efficacy, CH, and satisfaction were assessed at 6 months and 1 year post-procedure.
Main Results:
- Both R2 and R3 sympathicotomy demonstrated high efficacy with low recurrence rates (4.1% for R2, 4.2% for R3).
- R3 sympathicotomy showed a trend towards more dramatic recurrences compared to R2.
- R2 sympathicotomy showed a trend towards higher compensatory sweating (CH) levels than R3, though not statistically significant.
- Younger age, male sex, and higher sweating levels predicted treatment failure; older age correlated with increased CH.
Conclusions:
- Both R2 and R3 sympathicotomy are effective for massive palmar hyperhidrosis with acceptable CH rates.
- R3 sympathicotomy may have a higher risk of significant recurrence, potentially treatable with R2 reoperation.
- R2 sympathicotomy might be associated with a slightly higher incidence of CH compared to R3.
