title: Thoracoscopic sympathectomy for palmar hyperhidrosis. Ablate or resect?
abstract: 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.
authors.affiliation: 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
authors.forename: M
authors.initials: M
authors.lastname: Hashmonai
authors.forename: A
authors.initials: A
authors.lastname: Assalia
authors.forename: D
authors.initials: D
authors.lastname: Kopelman
mesh_terms: 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*