ENDOSCOPIC TRANSTHORACIC SYMPATHECTOMY IN THE TREATMENT OF PRIMARY HYPERHIDROSIS - A REVIEW OF 290 SYMPATHECTOMIES

Objectives: To describe the surgical technique of endoscopic transthor acic sympathectomy for the treatment of palmar hyperhidrosis and to id entify associated complications. Design: Prospective clinical study. S etting: University referral center. Patients: A consecutive series of 150 patients with primary palmar hyperhidrosis. Intervention: The surg ical procedure is performed under general anesthesia. A trocar and end oscope are inserted into the chest cavity. The sympathetic chain and t he second, third, and fourth ganglia are then identified, cauterized, and cut. After reinflation of the lung, the procedure is repeated on t he other side. Results: Two hundred ninety sympathectomies were perfor med with a 98% success rate. Complications of the procedure included p neumothorax in seven patients (2.4%), hemothorax in three (1.0%), and temporary Horner's syndrome in two (0.7%). Severe postoperative pain d uring the first 2 to 4 hours required treatment. Of 60 patients who we re followed up for 12 months, 50% developed compensatory sweating and 8.3% developed rebound sweating. Hyperhidrosis recurred in three patie nts. Conclusion: Endoscopic transthoracic sympathectomy is an effectiv e form of treatment for palmar primary hyperhidrosis, is associated wi th a low morbidity, and can be performed as an ambulatory procedure.