The choice of thoracoscopic sympathectomy in the treatment of palmar hyperhidrosis among different procedures

Abstract

Retrospective analyze the long-term efficacy and compensatory sweating of thoracoscopic sympathectomy in the treatment of palmar hyperhidrosis by different operative methods in order to search after a better operative method. Retrospective study of 643 cases (498 cases available) palmar hyperhidrosis who accepted video-assisted thoracoscopic bilateral sympathectomy during from 1995 to Aug 2008. The patients were divided into four groups by different operative methods. (1) Group A(n = 82): Thoracoscopic T2-4 sympathectomy was performed. (2) Group B (n = 135): Thoracoscopic T2 sympathectomy was performed. (3) Group C (n = 41): Thoracoscopic T2 sympathetic nerve clipped. (4) Group D (n = 240): Thoracoscopic T3-4 level sympathectomy plus bypass fiber (Kuntz fiber) resection on same level was performed. All procedures were successfully performed under thoracoscope without severe morbidity and mortality. The curative rate of palmar hyperhidrosis was 100.00%. The incidence of compensatory sweating were 54.9% (group A), 48.1% (group B), 48.8% (group C) and 28.8% (group D) respectively with significantly decrease in group D contrast to other three groups. The incidence of high-grade compensatory sweating which have important influences on daily life were 9.8% (group A), 10.4% (group B), 9.8% (group C) and 2.9% (group D) respectively with significantly decrease in group D. Other pairings have nonsignificance. The relapse rate were 1.2% (group A), 2.2% (group B), 7.3% (group C) and 0.8% (group D). Only when group D contrasted to group C has significantly decrease in the relapse rate (χ(2) = 8.423, P = 0.004). Other pairings have nonsignificance. The procedure of T3-4 sympathectomy plus bypass fiber resection is reasonable operative method to cure hyperhidrosis with the better curative effect and lowest incidence of compensatory hyperhidrosis.