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Compensatory Hyperhidrosis After ETS: Temporal Evolution and Predictors.

Erhan Ozer1, Basak Gorusun1, Teoman Ekim2

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Compensatory hyperhidrosis after endoscopic thoracic sympathectomy (ETS) for palmar hyperhidrosis occurs early and may improve spontaneously. Limited, single-level sympathectomy, preferably R4, reduces this complication risk.

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Area of Science:

  • Thoracic Surgery
  • Neurosurgery
  • Dermatology

Background:

  • Compensatory hyperhidrosis is a major complication of endoscopic thoracic sympathectomy (ETS) for palmar hyperhidrosis.
  • The temporal course and long-term predictors of compensatory hyperhidrosis are not well understood.

Purpose of the Study:

  • To investigate the temporal evolution of compensatory hyperhidrosis after ETS.
  • To identify predictors of compensatory hyperhidrosis, recurrence, and patient satisfaction following ETS for palmar hyperhidrosis.

Main Methods:

  • A multicenter retrospective study of 226 patients undergoing bilateral clip-based ETS.
  • Patients were stratified by surgical level (R3, R4, R2-R4, asymmetric).
  • Compensatory hyperhidrosis severity was assessed at 6, 12 months, and long-term follow-up (mean 98 months); logistic regression was used for analysis.

Main Results:

  • Complete palmar dryness was achieved in 84.5% of patients.
  • Compensatory hyperhidrosis occurred in 48.7%, exclusively within 6 months post-surgery, with 28.2% showing spontaneous regression.
  • Multi-level R2-R4 sympathectomy predicted higher compensatory hyperhidrosis risk (OR=2.18); single-level R4 was associated with lower burden. Recurrence, not compensatory hyperhidrosis, drove dissatisfaction.

Conclusions:

  • Compensatory hyperhidrosis emerges early post-ETS and can partially resolve spontaneously.
  • Multi-level sympathectomy increases compensatory hyperhidrosis risk without enhancing efficacy; favoring limited, single-level (R4) approaches is recommended.
  • Surgical level selection, smoking cessation, and patient counseling are crucial for managing outcomes after ETS.