title: Transthoracic endoscopic sympathectomy in the treatment of palmar hyperhidrosis--with emphasis on perioperative management (1,360 case analyses).
abstract: BACKGROUND
  Primary palmar hyperhidrosis (PH) is very common, and can be disabling. Various surgical methods for endoscopic sympathectomy have been advocated. We present a simple and effective method of treating PH by means of transthoracic endoscopic sympathectomy (TES).
  
  
  METHODS
  From July 1994 to May 1998, a total of 1,360 patients with hyperhidrosis palmaris underwent TES. There were 544 males and 816 females with a mean age of 23.1 years old (range, 5 to 60 years). All patients were placed in a half-sitting position under single-lumen intubational anesthesia. We performed the ablation of the T2 ganglion using either a 6- or 8-mm, 0-degree thoracoscope (Karl Storz Company, Germany)
  
  
  RESULTS
  In these 1,360 patients, 2,715 sympathectomies were performed. TES was usually accomplished within 15 min. Surgical complications were minimal: six cases of pneumothorax (0.44%), four cases of segmental collapse of lung (0.29%), and two wound infections (0.15%). There was no surgical mortality. The mean postoperative follow-up period was 27.8 months. A total of 1,292 patients (95%) had highly satisfactory results, although 1,140 patients (84%) have developed compensatory sweating of the trunk and lower limbs. The affected area was the axillae, back, abdomen, lower limbs (16%, 82%, 52%, and 78%, respectively). The recurrence rates of PH were 0.4% in the first year, 0.6% in the second year, and 1.1% in the third year.
  
  
  CONCLUSIONS
  TES is a simple, safe, and effective method of treating PH.
authors.affiliation: Department of Surgery, Changhua Christian Hospital, Chung Shan Medical and Dental College, Taichung, Taiwan, ROC.
authors.forename: T S
authors.initials: TS
authors.lastname: Lin
authors.forename: H Y
authors.initials: HY
authors.lastname: Fang
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D005260:Female; D005728:Ganglia, Sympathetic / Q000601:surgery; D006225:Hand; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications; D013562:Sympathectomy / Q000379:methods*; D013909:Thorax / Q000294:innervation; D016896:Treatment Outcome