An unusual case of excessive sweating affecting the right upper limb after bilateral endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: recurrence or compensatory hyperhidrosis?

Introduction Hyperhidrosis is excessive perspiration beyond physiological needs and can be primary (essential, idiopathic) or secondary to drugs, toxins, substance abuse, and several medical conditions. Primary hyperhidrosis generally involves the palms, axillae, and face. Herein, we report an unusual case of excessive sweating after endoscopic thoracic sympathectomy, which was misinterpreted as recurrence due to improper surgery. Methods A 31-year-old male patient underwent bilateral T3-T4 videothoracoscopic sympathicotomy for primary palmar hyperhidrosis. Results After the surgery, the patient complained about sweating of the right axillae and palm, and underwent reoperation at the right side, which revealed correct division of the sympathetic chain and absence of visible communicating nerves between the stubs. Subsequently, the patient presented with excessive sweating, greater than that prior to surgery, in the right upper limb. This condition was difficult to contextualise as either recurrence, given the correctness of the surgical procedure and higher amount of sweating compared with the preoperative state, or as compensatory hyperhidrosis, given the involvement of body areas affected by surgery. Conclusions Compensatory hyperhidrosis may involve areas affected by endoscopic thoracic sympathectomy and thus may be confused with recurrence due to incomplete surgery, leading to unnecessary surgical re-interventions.