Repeat transthoracic endoscopic sympathectomy for palmar and axillary hyperhidrosis

Background: Patients undergoing an unsuccessful sympathectomy experience dryness on one hand and excessive sweating on the other. This is embarrassing for the patients, and resolution of both a previous failed sympathectomy and recurrent hyperhidrosis is important. Methods: From September 1995 to January 1998, 24 patients (11 men and 13 women; mean age, 28.2 years) underwent repeat transthoracic sympathectomy (TES). The repeat TES was performed with patients under general anesthesia using either a standard single-lumen endotracheal tube (12 patients) or a double-lumen endotracheal tube (12 patients). Ablation of T2 and T3 ganglia and any Kuntz fiber was performed in treating patients with palmar hyperhidrosis, and a similar procedure was performed on T3 and T4 ganglia for patients with axillary hyperhidrosis. Results: The reasons for failure of the previous TES were pleural adhesion (14/24), intact T2 ganglion (5/24), aberrant venous arch drainage to the superior vena cava (2/24), incomplete interruption of sympathectic nerve (2/24), and possible reinnervation (1/24), The mean operation time was 28 min (range, 18-72 min). In all, 23 patients had a satisfactory result, without recurrence of palmar or axillary hyperhidrosis. The mean follow-up time was 22 months (range, 5-30 months). The average hospital stay was 1.8 days. There was no surgical mortality. Conclusion: Repeat TES is a safe and effective method for treating both an unsuccessful sympathectomy and recurrent palmar or axillary hyperhidrosis.