LB940 A comprehensive evaluation of thoracoscopic sympathectomy for severe primary palmar hyperhidrosis

Abstract

We assessed the efficacy of thoracoscopic sympathectomy (TS) in patients with severe primary palmar hyperhidrosis (PPH) with objective and subjective measures. We conducted two prospective institutional review board-approved studies. We evaluated healthy volunteers (controls) with measurement of palmar transepidermal water loss (TEWL; g/m2/h) and standardized questionnaires (Hyperhidrosis Disease Severity Scale [HDSS], Dermatology Life Quality Index [DLQI]). We evaluated PPH patients the same way at baseline, and 1 month and 1 year after TS and compared them to controls. We report medians and IQR (two-sample Wilcoxon for continuous variables; Chi-square for categorical variables). We evaluated 50 controls and 127 PPH patients. Control palmar TEWL was 106 g/m2/h (IQR 70), HDSS was 1 (IQR 0), and DLQI was 0 (IQR 0). PPH palmar TEWL was 146 g/m2/h (IQR 83), HDSS was 4 (IQR 1), and DLQI was 13 (IQR 8.5). Palmar TEWL and questionnaire scores were higher in PPH patients than in controls (TEWL p<0.05; HDSS and DLQI p<0.0001). 21 PPH patients underwent TS and the 1 month postop evaluation; 10 patients had a 1 year postop evaluation. Palmar TEWL 1 month after TS was 40 g/m2/h (IQR 13), and 1 year after TS was 28 g/m2/h (IQR 9.5); both were lower post TS than in controls (p<0.0001). Palmar TEWL 1 month and 1 year after BTS was lower than PPH palmar TEWL preop (p<0.004). At 1 month and 1 year post TS, DLQI scores were not different from controls, and they were lower than preop scores (1 month post TS PPH = 0 [IQR 2], 1 year post TS = 2.5 [IQR 5] p < 0.003). Post TS, HDSS scores at 1 month were 1 (IQR 0) and at 1 year were 2 (IQR 1), both values were higher than in controls (p<0.003). One-month and 1-year post TS HDSS scores were lower than preop scores (p<0.007). We demonstrate that after TS, PPH patients significantly improve and compare favorably to healthy controls.