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Patient Satisfaction after Thoracoscopic Sympathectomy for Palmar Hyperhidrosis: Do Method and Level Matter?
Amy Cheng1, Hege Johnsen2, Michael Y Chang3
1General Surgeon at the Los Angeles Medical Center in CA. amy.w.cheng@kp.org.
The Permanente Journal
|October 31, 2015
Summary
Surgical intervention for palmar hyperhidrosis (PH) offers high success rates and patient satisfaction, regardless of the specific surgical technique. Avoiding the R2 ganglion level can reduce the incidence of compensatory sweating, a common side effect.
Area of Science:
- Thoracic Surgery
- Surgical Outcomes
- Hyperhidrosis Management
Background:
- Palmar hyperhidrosis (PH) is often treated surgically, but the choice between sympathicotomy, sympathectomy, or clipping of the thoracic sympathetic chain varies by surgeon preference.
- Understanding the impact of different surgical methods and interruption levels is crucial for optimizing PH treatment.
Purpose of the Study:
- To investigate the outcomes of surgical interventions for palmar hyperhidrosis (PH).
- To determine if the surgical method or the level of sympathetic chain interruption affects patient outcomes and satisfaction.
Main Methods:
- Retrospective review of 635 patients undergoing thoracoscopic procedures for PH between 1995 and 2010.
- 210 patients (33%) responded to questionnaires assessing symptoms and satisfaction 6 months to 15 years post-procedure.
- Analysis of outcomes based on surgical method (sympathicotomy, sympathectomy, ligation) and sympathetic chain level interrupted.
Main Results:
- Overall palmar success rate was 85.4%, unaffected by the surgical method used.
- Compensatory hyperhidrosis occurred in 66.7% of patients when the R2 ganglion was not included, versus 80.6% when it was (p = 0.028).
- 76.2% of patients reported satisfaction with the results, and 85.7% would repeat the procedure.
Conclusions:
- Most patients experience relief from PH and are satisfied with surgical intervention, irrespective of the technique.
- Postoperative compensatory hyperhidrosis is common but does not significantly impact overall patient satisfaction.
- Interrupting the sympathetic chain at the R2 ganglion level is associated with a higher incidence of compensatory hyperhidrosis.
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