Long-Term Impact of Endoscopic Thoracic Sympathectomy for Primary Palmar Hyperhidrosis

Endoscopic thoracic sympathectomy (ETS) is the gold standard treatment for primary hyperhidrosis, with excellent short-term results. The potential for adverse effects, particularly compensatory sweating (CS), may affect long-term satisfaction. In this retrospective review we aimed to examine long-term results and quality of life (QOL) after ETS in the management of primary, dominantly palmar, hyperhidrosis from a single institution.

A review of patients who had undergone ETS for primary palmar or axillary hyperhidrosis between February 2004 and May 2015 was performed. Utilizing a modified questionnaire with validated components, patients were contacted to obtain responses designed to measure outcomes and QOL domains.

Of the 96 eligible patients, 58 (60%) consented and completed the questionnaire. The median time of survey from surgery was 60 months (interquartile range, 35 to 122 months). Increased QOL was reported in 84% (49 of 58) of patients, and increased ability to perform tasks in 86% (50 of 58). Satisfaction was identified in 97% (56 of 58) of patients, and 93% (54 of 58) reported that they would recommend the procedure. CS was reported in 84% (49 of 58), ranging from minor in 78% (38 of 49) to severe in 22% (11 of 49). There were 146 total CS areas involved, most commonly the back (78%, 38 of 49). One ETS reversal, for extreme CS, was performed. Nonetheless, 78% (38 of 49) reported CS to be less disruptive than preoperative hyperhidrosis.

This study confirms that the benefits of ETS are maintained in the long term. Although CS is the main cause for discontent postoperatively, it is still preferred over the distress experienced from palmar or axillary hyperhidrosis and QOL is increased despite CS.