A comparative study of thoracoscopic sympathicotomy versus local surgical treatment for axillary hyperhidrosis

Axillary hyperhidrosis affects approximately 1.4% of the population. Medical management is often frustrating, and the response generally transient. Surgical methods include thoracoscopic sympathectomy or sympathicotomy and local axillary surgery such as suction-curettage or en-bloc skin resection. Many case series with retrospective follow-up are available in the literature, but no comparative studies between surgical techniques have been published.

During a 9-year period, two groups of consecutive patients with isolated axillary hyperhidrosis underwent thoracoscopic sympathicotomy (n = 49) or local axillary surgery (n = 47) at the same university hospital, depending on referral or preference. Patients received identical questionnaires to investigate local effect and side effects after surgery.

Questionnaires were returned by 92% after a median of 26 months, with no significant difference between the two groups. Local effect was significantly better after axillary surgery compared with sympathicotomy (p < 0.001), but mild recurrent axillary symptoms were significantly more frequent after axillary surgery (51% versus 5%, p < 0.001). Compensatory and gustatory sweating were significantly more frequent after sympathicotomy (84% versus 25%, p < 0.001; and 54% versus 26%, p = 0.01, respectively).

Outcome after surgery for isolated axillary hyperhidrosis was significantly better after local surgical treatment compared with sympathicotomy. Local effect was better and side effects fewer, but milder recurrent symptoms were more frequent. Compensatory sweating also occurs after local axillary surgery and has not been reported before. Our results suggest that local axillary surgery is preferable for isolated axillary hyperhidrosis and that R2-R3 or R2-R4 sympathicotomy should be discouraged. Sympathicotomy should only be considered for patients who have additional palmar hyperhidrosis.