• R Rieger, S Pedevilla, and S Pöchlauer.
• Abteilung für Chirurgie, Landeskrankenhaus Gmunden, eine Gesundheitseinrichtung der Gespag, Gmunden, Osterreich. Roman.Rieger@gespag.at
• Chirurg. 2008 Dec 1; 79 (12): 1151-61.

BackgroundThoracic sympathectomy is a valuable treatment option for patients with primary hyperhidrosis. However, controversies exist about the optimal technique of sympathectomy and the association between localisation of the focal hyperhidrosis and postoperative results.Patients And MethodsRetrospective analysis was performed on prospectively collected data of 402 thoracic sympathectomies performed in 204 consecutive patients with palmar-plantar (n=123), palmar-axillary (34), isolated axillary (35), and craniofacial (12) hyperhidrosis. The standard procedure was video-assisted thoracoscopic resection of the sympathetic chain from T2 to T4/5.ResultsAll procedures were performed thoracoscopically without serious perioperative complications. Postoperative morbidity was 2.5% (10/402) including two cases of incomplete Horner's syndrome (0.5%). One hundred forty-three patients were followed for a mean of 21 months (6-86). Palmar hyperhidrosis was eliminated in 100% of cases and axillary hyperhidrosis in 98.5%. There were three axillary recurrences (1.5%). Of all patients, 60% suffered from transient postsympathectomy neuralgia which was mild in the majority of cases. Strong compensatory sweating occurred in 17% of patients with palmar-plantar and palmar-axillary hyperhidrosis and in 53% of patients with isolated axillary hyperhidrosis (P<0.001). In the palmar-plantar and palmar-axillary groups, 92% were very satisfied with the postoperative results, 90% reported increased quality of life, and 93% would repeat the operation. The corresponding numbers in patients with isolated axillary hyperhidrosis were 47%, 44%, and 66%, respectively (P<0.001).ConclusionVideo-assisted thoracoscopic resection of the sympathetic chain from T2 to T4-5 is safe and effective and leads in almost 100% of cases to the elimination of palmar and axillary hyperhidrosis. In contrast to the excellent results in patients with palmar-plantar and palmar-axillary hyperhidrosis, outcome in patients with isolated axillary hyperhidrosis was impaired by a high rate of disturbing compensatory sweating.

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