A retrospective cohort study of T3 versus T4 thoracoscopic sympathectomy for primary palmar hyperhidrosis and primary palmar hyperhidrosis with axillary and plantar sweating

Abstract

Introduction: Thoracoscopic sympathectomy (TS) has been proven to be a safe and effective treatment for primary palmar hyperhidrosis (PH). However, the complications include compensatory hyperhidrosis (CH), and over-dry hands may occur in some patients after TS. Aim: To compare the therapeutic effect of T3 and T4 TS on primary PH and primary PH with axillary and plantar sweating. Material and methods: We retrospectively analyzed 100 patients with PH who had undergone T3 (group A, n = 49) or T4 (group B, n = 51) TS in our department, with at least 1 year of postoperative follow-up. Results: At discharge, no major complications or deaths occurred in either group. The condition of sweaty hands was fully improved in 44 of 49 patients in group A and all patients in group B, with a significant difference (p = 0.031). After 12 months of follow-up, 18 (36.7%) patients in group A and 4 (7.8%) patients in group B developed CH, 16 (48.5%) patients in group A and 24 (77.4%) patients in group B had improved axillary sweating, with a significant difference (p < 0.05). The satisfaction rate of group B was significantly higher than that of group A (p < 0.01). Conclusions: Both T3 and T4 TS were safe and effective treatments for PH patients, but the incidence of CH in T4 TS was lower than that in T3 TS. T3 TS may be more suitable for patients with severe PH, while T4 TS had a better therapeutic effect on PH patients with axillary sweating.

Efficacy of videothoracoscopic sympathectomy for palmo-axillary hyperhidrosis: Quality of Life Change and patient satisfaction

“…8 In another study comparing the group undergoing only T3 sympathectomy and the group undergoing only T4 sympathectomy, signi cantly higher success was explained to be achieved in the group undergoing T3 sympathectomy. 9 Cutting the T3 and T4 sympathetic ganglia together was clari ed to increase the surgical success rate, and the success rate of isolated T4 sympathectomy in palmar sweating was low in the other research.…”

“…Xie et al reported that CH developed in 43% of patients undergoing T3 sympathectomy alone and in 12% of patients undergoing only T4 sympathectomy. 9 In another study, Yang et al stated that the frequency of CH was observed more frequently in the T3-T4 sympathectomy group than in the T3 sympathectomy group. 8 In contrast, Soares et al reported that compensatory hyperhidrosis developed in 85% of patients a er sympathectomy, and only 10% of these were intolerable.…”

“…Pneumothorax is the most common postoperative complication a er VTS. 9,11 Salim et al indicated that pneumothorax developed in 23% of the patients in their study conducted with 120 patients. 6 In the current study, the most common postoperative complication a er VTS was pneumothorax (8%).…”