Original article: general thoracic
Severity of compensatory sweating after thoracoscopic sympathectomy

https://doi.org/10.1016/j.athoracsur.2004.02.087Get rights and content

Abstract

Background

Compensatory sweating is a well-known side effect after sympathectomy for hyperhidrosis. It is often claimed to correlate with the extent of sympathectomy, but results from the literature are conflicting, and few have actually considered differences in the intensity of compensatory sweating.

Methods

A total of 158 patients underwent thoracoscopic sympathectomy for primary hyperhidrosis or blushing, or both. Sympathectomy was performed bilaterally at Th2 for facial hyperhidrosis/blushing (n = 49), Th2-3 for palmar hyperhidrosis (n = 62), and Th2-4 for axillary hyperhidrosis (n = 47).

Results

Follow-up by questionnaire was possible in 94% of patients after a median of 26 months. Compensatory sweating occurred in 89% of patients and was so severe in 35% that they often had to change their clothes during the day. The frequency of compensatory sweating was not significantly different among the three groups, but severity was significantly higher after Th2-4 sympathectomy for axillary hyperhidrosis (p = 0.04). Gustatory sweating occurred in 38% of patients, and 16% of patients regretted the operation.

Conclusions

Compensatory and gustatory sweating were remarkably frequent side effects after thoracoscopic sympathectomy for primary hyperhidrosis. We found no significant difference between the level of sympathectomy and the occurence of compensatory sweating. However, it appears that this is the first study to demonstrate that severe sweating is significantly more frequent after Th2-4 sympathectomy for axillary hyperhidrosis. We encourage informing patients thoroughly about these side effects before surgery.

Section snippets

Patients and methods

During a 6-year period (January 1997 to January 2003), 158 patients were treated at our institution for isolated or combinations of palmar or axillary hyperhidrosis or facial hyperhidrosis or blushing as shown in Figure 1. In the latter group, all patients suffered from blushing and 6 also complained of facial hyperhidrosis. Objective methods for quantifying sweating before surgery were not applied. The indications for operation were disabling hyperhidrosis or blushing as defined by the

Results

The median time spent in the operating room was 1 hour and 5 minutes (range, 35 minutes to 3 hours and 20 minutes). The median duration of the surgical procedure was 20 minutes (range, 10 minutes to 1 hour and 55 minutes). No conversion to open technique was necessary, and there was no operative mortality. One patient with persistent unilateral symptoms of palmar hyperhidrosis after sympathectomy was successfully treated at reoperation 1 week later. In 4 patients unilateral Horner's syndrome

Comment

Surgical treatment of primary hyperhidrosis is effective and is based on interruption of transmission of impulses from sympathetic ganglia to the eccrine sweat glands. A variety of different surgical approaches have been used over time with varying results 1, 4. The term “sympathectomy” is often used synonymously with “sympaticotomy,” which is the most commonly reported procedure during which the sympathectic trunk is divided but not resected. The more complex procedure of formal excision of

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