Indications and results of videothorascopic sympathectomy

Background and objectives: Thoracoscopic sympathectomy, for years an effect ive way to treat mainly palmar and axillar hyperhidrosis, experienced a rev ival since the application of the principles of minimally invasive surgery. We report the personal experiences of three surgeons with this technique, as well as patients' view of the outcome. Patients and methods: Between January 1990 and November 1997, 73 procedures were performed in 43 patients (23 males, 20 females, mean age 38.1 years, range 15-82 years), and the outcome was prospectively studied. Palmar hyper hidrosis without axillar symptoms was the indication for the operation in 2 7 patients (54 sympathectomies), Raynaud's syndrome in 15 (18 sympathectomi es), and causalgia in one. Thoracic ganglia 2-4 were always completely rese cted. Perioperative morbidity as well as patient satisfaction in the long-t erm course (standardized interview) 25.8 (1-77) months postoperatively were assessed. Results: The complication rate in all 73 sympathectomies was 8.2%. Only two severe incidents were observed: in one patient intermittent Horner's syndr ome (1.4%) occurred, and in another severe bleeding required conversion to open surgery (1.4%). Both complications occurred in the early study phase. The initial success rate in all 27 patients with hyperhidrosis was 100%. In 30% of these cases a mild partial relapse was observed, which did not inte rfere with their daily activities. 53% of the patients reported compensator y and 23% gustatory sweating. 9% would have refused the operation, had they known these side effects. In all patients with Raynaud's disease the ulcer ations healed completely. At the time of the interview, two patients (13%) complained of painless relapses. They too stated that they had refused the operation, if they had known about the relapses. Conclusions: Even in the longer-term course, thoracoscopic sympathectomy is rated subjectively successful by 93% of patients after treatment of hyperh idrosis of the upper extremities, and by 87% of patients after treatment of Raynaud's disease, despite some untoward effects and partial relapses.