Background: Upper thoracoscopic sympathectomy, obtained either by ablation
or resection of the appropriate ganglia, is now the preferred treatment for
primary palmar hyperhidrosis. Therefore, we undertook a review to compare
the relative efficacy of these two techniques.
Methods: A Medline search was performed for the years 1974-99 to identify a
ll published studies of thoracoscopic sympathectomy for hyperhidrosis.
Results: In all, 33 studies were identified and divided into two groups-abl
ation and resection. When the resection method was used, the immediate succ
ess rate was 99.76%, whereas the ablation method achieved dry hands in 95.2
% of cases (p = 0.00001). Palmar sweating recurred in 0% of patients treate
d via resection and 0-4.4% treated with ablation. Ptosis was noted in 0.92%
of cases after ablation and in 1.72% after resection (p = 0.017).
Conclusions: Resection yields superior results, yet the majority of surgeon
s ablate, probably because it is easier, re-quires a shorter operating time
, leads to fewer cases of Homer's syndrome, and because resympathectomy eve
ntually overcomes initial failure.