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T2-sparing vs T2-including sympathectomy for hyperhidrosis: a meta-analysis on compensatory sweating.
Lucas Monteiro Delgado1, Paula Duarte D'Ambrosio2, Rachid Eduardo Noleto da Nobrega Oliveira3
1Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Journal of Cardiothoracic Surgery
|June 26, 2026
Summary
T2-sparing sympathectomy significantly reduces compensatory sweating after primary hyperhidrosis treatment. Avoiding T2 ganglion resection minimizes postoperative complications, improving patient outcomes.
Area of Science:
- Thoracic surgery
- Surgical oncology
- Minimally invasive procedures
Background:
- Sympathectomy offers high success rates for primary hyperhidrosis.
- Compensatory sweating (CS) is a common, distressing complication.
- The role of T2 ganglion resection in CS incidence is debated.
Purpose of the Study:
- To compare T2-sparing versus T2-including sympathectomy for primary hyperhidrosis.
- To evaluate the impact of T2 resection on compensatory sweating incidence.
- To synthesize current evidence on surgical techniques for hyperhidrosis.
Main Methods:
- Systematic literature search of PubMed, Embase, and Cochrane Library up to July 2025.
- Meta-analysis of 11 studies involving 3,090 patients.
- Random-effects models used to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs).
Main Results:
- T2-sparing sympathectomy showed significantly lower incidence of overall CS (OR 0.38) and severe CS (OR 0.43).
- Results were consistent across study designs (randomized/non-randomized) and follow-up durations (short/long-term).
- Sensitivity analyses confirmed findings; no publication bias detected.
Conclusions:
- T2-sparing sympathectomy is associated with significantly reduced CS incidence.
- Avoiding T2 ganglion resection is recommended to minimize postoperative morbidity.
- Further prospective studies are warranted to validate these findings.
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