Upper dorsal thoracoscopic sympathectomy for palmar hyperhidrosis: improved intermediate-term results

Area of Science:

• Thoracic surgery
• Minimally invasive procedures
• Neurology

Background:

• Primary palmar hyperhidrosis is a condition causing excessive sweating in the hands.
• Surgical interventions aim to reduce sweating by interrupting sympathetic nerve pathways.
• Thoracoscopic sympathectomy is a minimally invasive approach to treat hyperhidrosis.

Purpose of the Study:

• To evaluate the immediate and mid-term outcomes of thoracoscopic upper dorsal sympathectomy (T2-T3) for primary palmar hyperhidrosis.
• To assess the efficacy and complication rates of this surgical procedure.

Main Methods:

• 106 sympathectomies were performed on 53 patients (15-44 years old) with palmar hyperhidrosis between June 1993 and October 1994.
• The T2-T3 thoracic ganglia were resected via electrocautery during a single surgical procedure for both sides.
• Follow-up was conducted for a mean of 19.25 months on 52 patients (104 limbs).

Main Results:

• All operated limbs achieved complete dryness immediately post-procedure, with no recurrence during follow-up.
• Short-term complications occurred in 11.3% of patients (atelectasis, pneumonia, pneumothorax, hemothorax).
• Long-term sequelae were observed in 81.1% of patients, including Horner's syndrome (17.3%), neuralgia (13.5%), and compensatory hyperhidrosis (67.3%).

Conclusions:

• Despite a high rate of long-term sequelae, 88.5% of patients reported subjective satisfaction with the procedure.
• The 100% success rate in achieving dry hands at mid-term follow-up makes this approach rewarding.
• Careful patient selection and management of complications are crucial for optimizing outcomes.