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Ann Thorac Surg 2006;81:1227-1233
© 2006 The Society of Thoracic Surgeons

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Original article: General thoracic

One-Year Follow-Up After Thoracoscopic Sympathectomy for Hyperhidrosis: Outcomes and Consequences

^a Medical City Dallas Hospital, Dallas, Texas
^b Cardiopulmonary Research Science and Technology Institute, Dallas, Texas

Accepted for publication November 3, 2005.

^_* Address correspondence to Dr Herbert, Medical City Dallas Hospital, 7777 Forest Lane, Ste C-740, Dallas, TX 75230 (Email: morley.herbert{at}hcahealthcare.com).

Presented at the Forty-first Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.

BACKGROUND: Thoracic sympathectomy is recognized as an effective treatment for patients with severe hyperhidrosis. While good early results have been documented, continuing efficacy and patient satisfaction has not been well-defined. We reviewed our results in patients who were at least one year out from surgery.

METHODS: All procedures were performed thoracoscopically using bilateral 3 mm ports and excision of a segment of the sympathetic chain by electrocautery. The level of sympathectomy depended upon clinical symptoms: T₂ for face/scalp, T₃ for palmar hyperhidrosis, and T₄ for axillary hyperhidrosis, or a combination of levels for multiarea sweating. All patients were followed-up at least 1 year postprocedure by mail questionnaire and/or telephone.

RESULTS: Two hundred twenty-two patients had undergone thoracoscopic sympathectomy for essential hyperhidrosis between Jan 1, 2002 and Nov 30, 2003, with 170 patients having at least one-year follow-up. The patients' preoperative assessment of the severity of sweating in the affected areas was compared with their one-year evaluation in order to determine the durability of the procedure. All affected areas continued to show significant improvement in sweating as compared with preoperative symptoms. Compensatory sweating was reported in 85% of our patients at one-year follow-up. Patients with a T₂ lesion were significantly more likely to have severe compensatory sweating than those with other levels; 48.8% vs 16.1% (p < 0.001). Patients with levels other than T₂ reported high degrees of satisfaction unrelated to their postoperative compensatory symptoms.

CONCLUSIONS: Patient satisfaction and perceived effectiveness with sympathectomy for palmar or axillary hyperhidrosis remain high even one year after the procedure. Inclusion of the T₂ lesion results in significantly more severe compensatory sweating and reduced satisfaction than other levels.

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