Quality of life and patient satisfaction after single-port endoscopic thoracic sympathectomy for primary focal hyperhidrosis: a follow-up of 250 patients

Background: If left untreated, severe types of primary focal hyperhidrosis (PFH) would have a negative impact on the quality of life (QoL) of the affected person. This study aimed to determine the efficacy of an endoscopic thoracic sympathectomy (ETS) and the degree of improvement in QoL and satisfaction after surgery. The intraoperative and postoperative complications were evaluated, especially compensatory hyperhidrosis (CH). We hypothesized that the selected sympathectomy levels will neither prevent nor reduce CH. Methods: A single-center retrospective study of 250 adult patients diagnosed with bilateral PFH underwent ETS of the second, third, and fourth thoracic sympathetic ganglion. We compared preoperative and postoperative hyperhidrosis severity score (HDSS) and QoL using Pearson correlation. The rate of CH and other complications during follow-up of 4 years were recorded. Results: Among 250 patients, 217 had a preoperative HDSS of three and 33 patients had a score of 4, when compared postoperatively HDSS was 0 in 145 patients (58%), one in 82 patients (32.8%), two in 22 patients (8.8%), and score 3 in one patient (0.4%) (P=0.097). QoL before operation in 201 patients was very bad (80.4%), while postoperatively, QoL was much better in 206 patients (82.4%) (P=0.0001). CH was seen only in 27 patients (10.8%), and only one was severe. Conclusion: ETS is safe and effective for severe cases of PFH. Sympathectomy at second, third, and fourth ganglion levels has an excellent outcome and higher patient satisfaction with minimal perioperative complications, including CH.