Endoscopic thoracic sympathectomy for isolated axillary hyperhidrosis

Background. Endoscopic thoracic sympathectomy is accepted as the treatment of choice for palmar hyperhidrosis. But the interest and the results of end oscopic thoracic sympathectomy for isolated axillary hyperhidrosis are stil l discussed. Patients and methods. In a series of 435 patients operated on for hyperhidr osis of the upper limbs during the 5 past years, 23 were suffering from iso lated axillary hyperhidrosis (5.2 p. 100) All patients had been previously treated by local agents and 3 had iontophoresis. All patients underwent a b ilateral endoscopic thoracic sympathectomy that was performed in one stage. Sympathectomy was done according to the usual technique but was extended d own to Tg. All patients were then contacted by phone to answer a detailed q uestionnaire. Four patients were lost for follow-up. The mean follow-up of the 19 remaining patients was 26 months (ranging 3 to 41 months). Results. There was no intraoperative or postoperative complication. All pat ients were discharged the day after surgery. All but one (95 p. 100) were c ured from their axillary hyperhidrosis. All of them experienced compensator y sweating (100 p. 100). This compensatory sweating was considered as mild by 8 patients, as embarrassing in 8 and as distressing in 3. Eleven patient s complained of excessive dryness of the hands. This was considered as a mi nor adverse effect by 8 patients and as problematic by 3 patients. Finally, 16 patients were satisfied while 3 claimed they regretted having been oper ated on. Conclusion. The rate of compensatory sweating and the rate of dissatisfacti on are higher after endoscopic thoracic sympathectomy for axillary hyperhid rosis than after endoscopic thoracic sympathectomy for palmar hyperhidrosis . Endoscopic thoracic sympathectomy for axillary hyperhidrosis should be fo reseen only when all other therapies have been attempted.