Thoracoscopic sympathectomy for hyperhidrosis: Analysis of 642 procedures with special attention to horner's syndrome and compensatory hyperhidrosis

Scott D. Wait, Brendan D. Killory, Gregory P. Lekovic, Francisco A. Ponce, Kathy J. Kenny, Curtis A. Dickman

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

Background: Hyperhidrosis (HH) profoundly affects a patient's well-being. Objective: We report indications and outcomes of 322 patients treated for HH via thoracoscopic sympathectomy or sympathotomy at the Barrow Neurological Institute. Methods: A prospectively maintained database of all patients who underwent sympathectomy or sympathotomy between 1996 and 2008 was examined. Additional follow-up was obtained in clinic, by phone, or by written questionnaire. Results: A total of 322 patients (218 female patients) had thoracoscopic treatment (mean age 27.6 years; range, 10-60 years). Mean follow-up was 8 months. Presentations included HH of the palms (43 patients, 13.4%), axillae (13 patients, 4.0%), craniofacial region (4 patients, 1.2%), or some combination (262 patients, 81.4%). Sympathectomy and sympathotomy were equally effective in relieving HH. Palmar HH resolved in 99.7% of patients. Axillary or craniofacial HH resolved or improved in 89.1% and 100% of cases, respectively. Hospital stay averaged 0.5 days. Ablating the sympathetic chain at T5 increased the incidence of severe compensatory sweating (P =.0078). Sympathectomy was associated with a significantly higher incidence of Horner's syndrome compared with sympathotomy (5% vs 0.9%, P =.0319). Patients reported satisfaction and willingness to undergo the procedure again in 98.1% of cases. Conclusion: Thoracoscopic sympathectomy is effective and safe treatment for severe palmar, axillary, and craniofacial HH. Ablating the T5 ganglion tends to increase the severity of compensatory sweating. Sympathectomy led to a higher incidence of ipsilateral Horner's syndrome compared with sympathotomy.

Original languageEnglish (US)
Pages (from-to)652-656
Number of pages5
JournalNeurosurgery
Volume67
Issue number3
DOIs
StatePublished - Sep 1 2010

Keywords

  • Hyperhidrosis
  • Sympathectomy
  • Thoracoscopy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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