Thoracoscopic sympathectomy for palmar hyperhidrosis. Ablate or resect?
BACKGROUND
Upper thoracoscopic sympathectomy, obtained either by ablation or resection of the appropriate ganglia, is now the preferred treatment for primary palmar hyperhidrosis. Therefore, we undertook a review to compare the relative efficacy of these two techniques.


METHODS
A Medline search was performed for the years 1974-99 to identify all published studies of thoracoscopic sympathectomy for hyperhidrosis.


RESULTS
In all, 33 studies were identified and divided into two groups-ablation and resection. When the resection method was used, the immediate success rate was 99.76%, whereas the ablation method achieved dry hands in 95.2% of cases (p = 0.00001). Palmar sweating recurred in 0% of patients treated via resection and -4.4% treated with ablation. Ptosis was noted in 0.92% of cases after ablation and in 1.72% after resection (p = 0.017).


CONCLUSIONS
Resection yields superior results, yet the majority of surgeons ablate, probably because it is easier, requires a shorter operating time, leads to fewer cases of Horner's syndrome, and because resympathectomy eventually overcomes initial failure.
Hashmonai
M
M
Department of Surgery B, The Rambam Medical Center and the Faculty of Medicine, Technion Israel Institute of Technology, P.O. Box 9621, Haifa 31096, Israel. hasmonai@inter.net.il
Assalia
A
A
Kopelman
D
D
D006225:Hand; D006732:Horner Syndrome / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods*; D013906:Thoracoscopy / Q000009:adverse effects / Q000379:methods*