Bilateral Simultaneous T3/T4 Endoscopic Thoracic Sympathectomy for Treatment of Primary Palmar and Axillary Hyperhidrosis

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Objective: This study was conducted to evaluate the safety, and complications of bilateral simultaneous endoscopic thoracic sympathectomy by resection of T3/T4 sympathetic ganglia in treatment of primary palmar and axillary hyperhidrosis. Patients and methods: This prospective study was conducted in General Surgery Unit at Ain Shams University Hospitals in the period from May 2012 to June 2014 on twenty patients. All cases underwent thoracoscopic sympathectomy of T 3, 4 ganglia on the right &left sides at the same setting. In this prospective interventional study, we had 20 patients with severe primary hyperhidrosis with failed medical treatment who underwent bilateral simultaneous Endoscopic Thoracic Sympathectomy (ETS). Results: Of 20 patients there were 13 males (65%) and 7 females (35%). The mean age was 23.9 ±7.8. The mean operating time was 76.2 min. ± 21.4 min. all cases were completed laparoscopically and there were no serious intraoperative complications. The average length of hospital stay was 2.8 days (range: 2-5 days). The average postoperative follow-up period was 14.6 months (range: 6-20 months). Residual pneumothorax occurred in 3 patients (15%), Surgical emphysema on either side was seen in the early postoperative period in 3 patients (15%). The postoperative intercostal pain was observed in all cases (100%). most patients (19/20: 95% of patients) experienced compensatory sweating of varying degrees in other parts of the body, which was bilateral and symmetrical, most commonly at the lower back. Excessive hand dryness was reported in 8 patients (40%), one of them had to use moisturizing hand cream daily.Patients’ Satisfaction with the overall results of the operation were assessed .Only one patient (5%) stated that they were ‘dissatisfied’ and regretted having undergone the operation Conclusion: ETS with T3/T4 ganglia resection is a safe method for patients complaining of severe palmar or combined palmar and axillary hyperhidrosis . From the results of this study, we recommend using smaller ports and performing a more limited approach (T3 or T4) to patients with moderate primary hyperhidrosis symptoms to avoid dissatisfaction due to severe compensatory sweating and palmar overdryness.