Assessment of outcome after thoracoscopic sympathectomy for hyperhidrosis in a specialized unit

Transthoracic endoscopic electrocautery of the sympathetic chain is increasingly being used as a technique for producing the effects of upper thoracic sympathectomy. In November 1990 we introduced this operation as a regional service in Northern Ireland and have assessed the results in patients with idiopathic hyperhidrosis of the palms and axillae. There were 92 sympathectomics carried out for hyperhidrosis on 47 patients between 26 November 1990 and 6 September 1993. Full follow-up was possible in 45 patients (96%) at a median of 13 months (range 3-36) after the operation. Symptoms were improved in 43 patients (96%) at review. In three patients surgery failed to control symptoms on one side, and in two there was bilateral recurrence at 4 and 8 months after initial good results. Compensatory hyperhidrosis occurred in 35 patients (56%) and was severe in 4 (9%). Nine of 34 patients (34%) with plantar symptoms reported improvement in these post-operatively. This paper, with its high level of full follow-up, confirms thoracoscopic sympathectomy to be effective treatment for both palmar and axillary hyperhidrosis. Patient selection, however, is important and the risk of compensatory hyperhidrosis must be fully explained.