Long-term results of bilateral endoscopic thoracic sympathectomy for palmar and axillary hyperhidrosis: an eight-year experience

Background: This study aims to evaluate the long-term results of endoscopic thoracic sympathectomy (ETS) in patients who are refractory to medical treatment and are operated due to palmar and axillary hyperhidrosis which severely affect their social life. Methods: Between June 2004 and June 2011, we retrospectively analyzed 70 two-sided simultaneous ETS operations which were performed on 35 patients (18 males, 17 females; mean age 24 +/- 5.7 years; range 17-40 years). Two (97.1%) or three (2.9%) thoracoports were used endoscopically for the resection of sympathetic ganglions on level T2-3, T2-4 and T2-5 and for cauterization of the Kuntz's nerve. Patients were analyzed in terms of surgical technique applied, duration of surgery, intra- and postoperative complications, long-term results and patient satisfaction. The mean follow-up was 37.9 months (range, 8-81 months). Results: No surgical mortality was observed. Pneumothorax requiring a postoperative intervention developed in one patient (2.9%). Long-term follow-up revealed compensatory hyperhidrosis (8% severe, 12% moderate, 80% mild) involving various parts of the body in 25 patients (71.4%) and partial recurrence in one patient (2.9%). Thirty-three patients (94.3%) reported that they were satisfied with the results of ETS, while two (5.7%) reported partial satisfaction. Conclusion: Despite the risk for compensatory hyperhidrosis in the long-term, we believe that ETS is an effective treatment method for the patients with palmar and axillary hyperhidrosis who are well-informed and carefully selected preoperatively with lower morbidity, mortality and higher satisfaction rates in the long-term follow-up period.