Long-term results of a randomized controlled trial of T2 versus T2-T3 ablation in endoscopic thoracic sympathectomy for palmar hyperhidrosis

Background Despite good short-term results and patient satisfaction with endoscopic thoracic sympathectomy (ETS), there has been much debate on the level of sympathectomy for treatment of palmar hyperhidrosis (PH) in terms of long-term clinical outcomes. Objective The aim of the study was to analyze the long-term recurrence and compensatory hyperhidrosis (CH) rates of ETS, comparing single-level T2 against multi-level T2-T3 ablation in single patients. Methods Patients who had undergone treatment for PH with unilateral T2 and contralateral T2-T3 ablation in ETS were retrospectively reviewed. They were subjected to telephone interview using standardized set of interview script and questionnaire with a scoring system similar to hyperhidrosis disease severity scale. All patients were evaluated for comparison of symptom resolution, site and severity of CH, and satisfaction rates. To compare between T2 and T2-T3, the level of sympathectomy on one side is matched to the ipsilateral recurrence of PH and CH occurrence. Results Twenty-two patients with a mean age of 36.5 years could be reached. The mean follow-up was 8 years (range 38-153 months). The global recurrence rate for PH is 18 %. CH was observed in 20 (91 %) patients, and trunk compensation was the most common (18/ 22-82 %), followed by lower limb (14/22-64 %) and axilla (10/22-45 %). Overall, 72.8 % (16) of the patients were satisfied with the operation. Among the six patients who were not satisfied, two patients reported recurrence of symptoms, while four patients experienced some form of compensation. There was no absolute difference in the severity of sweating bilaterally for patients who reported recurrence of PH. The site and severity of CH were also bilaterally symmetrical for all patients. Conclusion There was no difference in recurrence rates and CH between single-level (T2) and multi-level (T2-T3) ETSs in the long term.