Video-assisted transthoracic sympathectomy in the treatment of primary hyperhidrosis: Friend or foe?

The authors hypothesize that palmar hyperhidrosis is a systemic manifestati on of abnormal sudomotor function; consequently, thoracoscopic sympathectom y to alleviate symptoms in the hands may result in heat dissipation because sweating is transferred to other sites. To investigate this phenomenon and to determine whether it adversely affects patient satisfaction, a standard questionnaire was administered to 626 patients who underwent sympathectomy at a university-associated public hospital between 1991 and 1998; only pat ients treated at least 6 months before questionnaire distribution were incl uded in the study. Replies were received from 336 (53.7%) individuals. The surveyed patients underwent bilateral T2, T3 (palmar sweating), or T3, T4 ( axillary sweating) sympathectomy by a standard video-assisted transthoracic technique. Main outcome measures included the incidence of dry hands, comp ensatory sweating, chest pain, upper-limb muscle weakness, shortness of bre ath, and gustatory phenomena; in addition, patient perception of the succes s of the surgical procedure was assessed. After sympathectomy, 97.3% (P < 0 .0001) and 29.1% (P < 0.001) of patients reported significant improvement i n palmar hyperhidrosis and axillary sweating, respectively. Postsurgery, se vere compensatory sweating was experienced in 90% of patients (P < 0.0001). The sites of compensatory sweating were the back (75%), abdomen (51%), fre t (23%), groin and thigh (13%), chest (13%), and axillae (8%). Transient wh ole-body sweating for no apparent reason was experienced in 30% of patients . Thirty-seven patients (11%) regretted having undergone the surgical proce dure. In contrast, 25% and 64% of patients were either satisfied or very sa tisfied with the outcome of the procedure. From the survey results, the aut hors conclude that palmar hyperhidrosis is a systemic manifestation of abno rmal sudomotor function and that thoracic sympathectomy may alleviate sympt oms in a large proportion of patients. However, for some individuals, compe nsatory sweating may prove to be an equally troublesome handicap. Because t he occurrence of severe compensatory sweating is unpredictable, a reversibl e sympathectomy may be desirable.