Unilateral versus Bilateral T3 Ganglionectomy in Primary Palmar Hyperhidrosis Patients

Area of Science:

• Thoracic surgery
• Surgical outcomes
• Hyperhidrosis treatment

Background:

• Primary palmar hyperhidrosis (PPH) is a condition characterized by excessive hand sweating, significantly impacting patients' quality of life.
• Endoscopic thoracic sympathectomy (ETS), specifically T3 ganglionectomy, is a recognized treatment for PPH.
• A major concern with ETS is the risk of compensatory hyperhidrosis (CH), where sweating increases in other body areas post-surgery.

Purpose of the Study:

• To compare the incidence of compensatory hyperhidrosis (CH) and patient satisfaction between unilateral and bilateral T3 ganglionectomy for primary palmar hyperhidrosis (PPH).
• To evaluate the effectiveness of unilateral versus bilateral ETS in managing PPH symptoms.
• To identify potential differences in adverse effects, specifically CH, between the two surgical approaches.

Main Methods:

• A retrospective analysis of 118 patients with severe PPH who underwent either unilateral (n=41) or bilateral (n=77) T3 ganglionectomy.
• Data collected included patient characteristics, surgical outcomes, patient satisfaction, and incidence of CH at 3 months post-operation.
• Statistical analysis was performed to compare outcomes between the unilateral and bilateral ETS groups.

Main Results:

• Unilateral T3 ganglionectomy resulted in significantly higher patient satisfaction (93% very satisfied) compared to bilateral T3 ganglionectomy (61% very satisfied) (p < 0.001).
• The incidence of CH was substantially lower in the unilateral group (20% experienced CH) versus the bilateral group (57% experienced mild CH) (p = 0.007).
• Common CH areas included the back, thighs, chest, abdomen, and hips; 7.5% in the unilateral group showed contralateral sweating improvement, with 22% eventually needing contralateral ganglionectomy.

Conclusions:

• Unilateral T3 ganglionectomy for PPH is associated with superior patient satisfaction and a significantly reduced risk of compensatory hyperhidrosis compared to bilateral T3 ganglionectomy.
• These findings suggest that unilateral ETS may be the preferred surgical option for patients aiming for better symptom relief and fewer adverse effects.
• Further long-term studies are warranted to definitively confirm the long-term efficacy and safety of unilateral ETS in managing PPH.