The results of thoracoscopic sympathetic trunk transection for palmar hyperhidrosis and sympathetic ganglionectomy for axillary hyperhidrosis

Objectives: to review our total experience of thoracoscopic sympathetic tru nk transection for the treatment of palmar hyperhidrosis and second and thi rd thoracic sympathetic ganglionectomy for axillary hyperhidrosis. Design: longitudinal cohort study following up consecutive patients for 0.3 to 5.5 years. Subjects: fifty-four consecutive patients undergoing thoracoscopic sympathe ctomy for hyperhidrosis. Methods: prospective evaluation of immediate technical success, complicatio ns, late recurrence of hyperhidrosis and patient acceptability. Results: 100% initial cure for palmar hyperhidrosis, 91% of sympathetic gan glionectomies for axillary hyperhidrosis were technically successful and in itially curative. Compensatory, sweating 44% patients, most severe after bi lateral sympathetic ganglionectomy. Complications occurred in 14% patients, all resolving without further intervention. There were no cases of Horner' s syndrome. 13% patients reported a return of some palmar sweating. 5.4% pa tients developed recurrent palmar hyperhidrosis at 6, 15 and 21 months post operatively. Conclusion: transection of the sympathetic trunk between the first and seco nd thoracic sympathetic ganglia initially curves 100% of patients treated p rimarily for palmar hyperhidrosis. Technically successful 2nd and 3rd thora cic sympathetic ganglionectomy initially cures 100% of patients with axilla ry hyperhidrosis. Compensatory sweating is common after bilateral sympathec tomy, Recurrent palmar hyperhidrosis occurs in 5.4% of cases, but can be cu red by a second thoracoscopic sympathectomy. Horner's syndrome is an avoida ble complication of thoracoscopic sympathectomy.