ENDOSCOPIC VERSUS TRANSAXILLARY THORACIC SYMPATHECTOMY FOR PRIMARY AXILLARY AND PALMAR HYPERHIDROSIS AND OR FACIAL BLUSHING - 5-YEAR-EXPERIENCE/

Thoracic sympathectomy is effective in the permanent cure of primary a xillary and palmar hyperhidrosis and facial blushing, which can be so troublesome for patients that their social and professional relations can be affected. Between October 1988 and April 1994, a total of 50 th oracic sympathectomies (10 surgical and 40 endoscopic) were performed on 5 and 23 patients, respectively. The operations were performed unil aterally, followed by the contralateral intervention after a period of 6-8 weeks. The thoracic ganglia T2-T5 were resected for hyperhidrosis . If the patient suffered from blushing, the lower 1/3 of the stellate ganglion was also resected. Postoperatively, all the operated limbs w ere warm and dry. In the group of patients who were operated bilateral ly, only one had persistent facial blushing. The efficacy for blushing in this series was therefore 93.3%. The late relapse rate of sympathe tic activity was 14.3%. Compensatory sweating was seen in 67%, gustato ry sweating in 37.5% and phantom sweating in 29% of the patients. None of them considered these side effects to be troublesome. Although the re is no difference between transaxillary thoracic sympathectomy and t he endoscopic intervention in terms of efficacy, the latter is associa ted with less postoperative pain, shorter hospital stay and a rapid re covery. The thoracic sympathectomy is the treatment of choice for prim ary hyperhidrosis and excessive facial blushing.