title: Repeat transthoracic endoscopic sympathectomy for palmar and axillary hyperhidrosis.
abstract: BACKGROUND
  Patients undergoing an unsuccessful sympathectomy experience dryness on one hand and excessive sweating on the other. This is embarrassing for the patients, and resolution of both a previous failed sympathectomy and recurrent hyperhidrosis is important.
  
  
  METHODS
  From September 1995 to January 1998, 24 patients (11 men and 13 women; mean age, 28.2 years) underwent repeat transthoracic sympathectomy (TES). The repeat TES was performed with patients under general anesthesia using either a standard single-lumen endotracheal tube (12 patients) or a double-lumen endotracheal tube (12 patients). Ablation of T2 and T3 ganglia and any Kuntz fiber was performed in treating patients with palmar hyperhidrosis, and a similar procedure was performed on T3 and T4 ganglia for patients with axillary hyperhidrosis.
  
  
  RESULTS
  The reasons for failure of the previous TES were pleural adhesion (14/24), intact T2 ganglion (5/24), aberrant venous arch drainage to the superior vena cava (2/24), incomplete interruption of sympathetic nerve (2/24), and possible reinnervation (1/24). The mean operation time was 28 min (range, 18-72 min). In all, 23 patients had a satisfactory result, without recurrence of palmar or axillary hyperhidrosis. The mean follow-up time was 22 months (range, 5-30 months). The average hospital stay was 1.8 days. There was no surgical mortality.
  
  
  CONCLUSIONS
  Repeat TES is a safe and effective method for treating both an unsuccessful sympathectomy and recurrent palmar or axillary hyperhidrosis.
authors.affiliation: General Thoracic Surgery, Changhua Christian Hospital, No. 135, Nan-Siau Street, Changhua City, Taiwan, ROC.
authors.forename: T S
authors.initials: TS
authors.lastname: Lin
authors.forename: H Y
authors.initials: HY
authors.lastname: Fang
authors.forename: C Y
authors.initials: CY
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D001365:Axilla; D004724:Endoscopy; D005260:Female; D006225:Hand; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D013562:Sympathectomy / Q000379:methods; D017211:Treatment Failure