Thoracoscopic limited T-3 sympathicotomy for primary hyperhidrosis: Prevention for compensatory hyperhidrosis

Object. Compensatory hyperhidrosis is a major and troublesome complication of thoracoscopic sympathectomy for primary hyperhidrosis. The incidence of compensatory hyperhidrosis has been reported to be as high as 50 to 97% in the patients who underwent sympathetic ganglia resection. In this study the authors evaluate the role of thoracoscopic T-3 sympathicotomy for primary hyperhidrosis and the prevention of compensatory hyperhidrosis. Methods. Thoracoscopic T-3 sympathicotomy was performed in 27 patients with either isolated palmar hyperhidrosis (24 cases) or that in combination with axillary hyperhidrosis (three cases) during a 3-year period. In the cases of combined palmar/axillary hyperhidrosis, the T-4 sympathetic ganglion also was coagulated. The mean follow-up period was 19.7 months. Surgery-related results were determined on the basis of complications, compensatory hyperhidrosis, and patient-related satisfaction. In the immediate postoperative period all 24 patients with palmar hyperhidrosis reported complete alleviation of their symptoms. One patient with palmar/axillary hyperhidrosis in whom axillary hyperhidrosis did not completely resolve underwent a repeated T-4 sympathicotomy 1 month after the initial surgery. Another patient suffered mild compensatory hyperhidrosis of the trunk 1 month postoperatively. The long-term satisfaction rate in all 27 patients was high. One patient required placement of a chest tube to treat pneumothorax. Other complications such as Horner syndrome, intercostal neuralgia, gustatory hyperhidrosis, and pulmonary edema were not observed. Conclusions. Thoracoscopic limited T-3 sympathicotomy is an effective method to treat primary hyperhidrosis, its rate of compensatory hyperhidrosis is low, and its rate of long-term patient satisfaction is high.