Long-term results of 630 thoracoscopic sympathicotomies for primary hyperhidrosis: the Vienna experience.
OBJECTIVE
To evaluate of the results of thoracoscopic sympathicotomy for upper limb hyperhidrosis with a median observation period of more than 15 years.


METHODS
Retrospective clinical observation study.


METHODS
University-affiliated tertiary referral centre.


METHODS
630 consecutive operations in 352 patients (median age 30.1 yrs) for primary palmar (68%), axillary (12.7%) and combined hyperhidrosis (19.3%).


METHODS
Thoracoscopic sympathicotomy from below T1 to T4 including the fibres of Kuntz using electrocautery through single site access.


METHODS
Perioperative success and complication rates (all patients); long-term follow-up by a questionnaire and/or clinical examination (83.3% of patients) after a median period of 16 yrs. Calculation of statistical significance of differences between groups with c2-test.


RESULTS
67.8% of patients were fully satisfied, 25.7% were partially satisfied and would again agree to the operation. In 93% the procedure cured hyperhidrosis permanently. Compensatory and gustatory sweating was observed in 67% and 47% of cases, respectively. Overall success was significantly (p < 0.001) lower in the group with axillary hyperhidrosis. Main complications: drainage for pneumothorax 1.3%, Horner's syndrome in 3.8%, subcutaneous emphysema 2.1%.


CONCLUSIONS
Thoracoscopic sympathicotomy proved to be highly effective even after long-term follow-up. Compensatory sweating impairs patients' satisfaction in some cases.
Zacherl
J
J
Department of General Surgery, University Clinic of Surgery, University of Vienna, Vienna General Hospital, Austria. johannes.zacherl@akh-wien.ac.at
Huber
E R
ER
Imhof
M
M
Plas
E G
EG
Herbst
F
F
Függer
R
R
D000293:Adolescent; D000328:Adult; D001317:Austria; D001365:Axilla; D002648:Child; D004724:Endoscopy; D006225:Hand; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013562:Sympathectomy / Q000379:methods*; D013906:Thoracoscopy; D016896:Treatment Outcome