Video-assisted thoracoscopic sympathectomy for thoracic three versus thoracic four for the treatment of primary hyperhidrosis (single-center study)

Background Hyperhidrosis is a pathologic disease of excessive sweating in amounts greater than the physiologically necessary thermoregulation. Although hand sweating does not have a significant effect on the health of patients, it can be uncomfortable to shake hands, complicate the writing, and cause humiliation and psychological distress. The primary treatment for patients with the disease is video-assisted thoracic sympathectomy (VATS) to be done with accuracy, with improved health care and good outcomes. Aim The aim was to assess the effect VATS on patient's quality of life according to the level of sympathectomy performed, as well as the presence of postoperative complications. Patients and methods This is a comparative randomized study that was conducted at Al-Zahraa University Hospital. A total of 126 patients with palmar hydrosis were involved in this study. The authors included patients from 16 to 40 years, in whom the sweating had a negative effect on their work. The authors have classified patients into two groups, those who underwent VATS on T3 and those who on T4 level, randomly. The authors followed patients at 1, 6, 12, and 24 months. Results The study was conducted on 126 patients, comprising 27.7% males and 72.3% females, with mean age of 25.8+5.8 and 25.2+4.4 in T3 and T4 groups, respectively. The incidence of compensatory hyperhidrosis was significantly lower in T4 group at 6 and 12 months, and also it was lower at long-term follow-up of 24 months, but with no significance statistically. We have noticed high rates of satisfaction of different degrees in both groups. T4 group showed better efficacy in limiting compensatory hyperhidrosis compared with T3 group. Conclusion Thoracoscopic T4, T3 sympathectomy provides very good results, with very low incidence of compensatory hyperhidrosis. T4 appears to be the best segment for treatment of primary hyperhidrosis.