ASSESSMENT OF OUTCOME AFTER THORACOSCOPIC SYMPATHECTOMY FOR HYPERHIDROSIS IN A SPECIALIZED UNIT

Transthoracic endoscopic electrocautery of the sympathetic chain is in creasingly being used as a technique for producing the effects of uppe r thoracic sympathectomy. In November 1990 we introduced this operatio n as a regional service in Northern Ireland and have assessed the resu lts in patients with idiopathic hyperhidrosis of the palms and axillae . There were 92 sympathectomies carried out for hyperhidrosis on 47 pa tients between 26 November 1990 and 6 September 1993. Pull follow-up w as 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 r eview. In three patients surgery failed to control symptoms on one sid e, and in two there was bilateral recurrence at 4 and 8 months after i nitial good results. Compensatory hyperhidrosis occurred in 35 patient s (56%) and was severe in 4 (9%). Nine of 34 patients (34%) with plant ar symptoms reported improvement in these post-operatively. This paper , with its high level of full follow-up, confirms thoracoscopic sympat hectomy to be effective treatment for both palmar and axillary hyperhi drosis. Patient selection, however, is important and the risk of compe nsatory hyperhidrosis must be fully explained.