Surgical treatment of palmar hyperhidrosis before thoracoscopy: experience with 475 patients

Between the years 1968-1992, 475 patients underwent simultaneous bilateral upper dorsal sympathectomy by the supraclavicular approach for severe palmar hyperhidrosis. For the purpose of comparing outcomes of the open surgical method with the increasingly used thoracoscopic procedure, we reviewed the clinical data of our patients. The incidence of severe palmar hyperhidrosis in the young population in Israel is 1-2/1,000. Surgical excision of the T2 and T3 ganglia was effective in drying the hands of all patients, who had frozen section confirmation of removal of a ganglion. At follow-up, hyperhidrosis recurred in 5.3% of limbs. Mild transient Horner's syndrome occurred in 12% of procedures, but only in 5 patients was it permanent. The main drawback of the open surgical approach lies in the postoperative complications. The effectiveness of the thoracoscopic approach will be judged by immediate and late results, and by the expected reduction in postoperative morbidity.