title: Role of video-assisted thoracoscopic sympathectomy in the treatment of primary hyperhidrosis.
abstract: BACKGROUND
  Essential hyperhidrosis is a frequent disorder causing significant functional impairment. The advent and development of video-assisted thoracoscopic techniques now allows thoracic sympathectomy to be carried out precisely and safety with good results and minimal morbidity.
  
  
  OBJECTIVE
  To assess the impact of video-assisted thoracic sympathectomy in patients diagnosed as presenting severe and disabling hyperhidrosis.
  
  
  METHODS
  This was a longitudinal study of the clinical course of all hyperhidrosis cases selected for surgery between May 1999 and January 2003.
  
  
  METHODS
  Division of Thoracic Surgery, Universidade Federal de S o Paulo (UNIFESP).
  
  
  METHODS
  743 patients with surgery indicated due to palmar hyperhidrosis (49.8%), palmar-axillary hyperhidrosis (38.1%), craniofacial hyperhidrosis (8.9%) or isolated axillary hyperhidrosis (2.8%).
  
  
  METHODS
  Video-thoracoscopic sympathectomy was performed, isolating the second thoracic ganglion (T2) in all patients, with additional sympathectomy of T3 and T4 if necessary.
  
  
  METHODS
  The clinical course was followed up via questionnaires, phone calls, letters and statements. Simple questions were asked regarding the disappearance of symptoms and presence and intensity of compensatory sweating.
  
  
  RESULTS
  The surgery was regarded as efficient in all cases of palmar hyperhidrosis. In the craniofacial hyperhidrosis cases, partial recurrence of the symptoms occurred in 2 cases (3.0%). Partial recurrence or persistence of symptoms occurred in 20% of the patients with predominantly axillary symptomatology. The compensatory sweating was considered disagreeable or uncomfortable by about 30% of the patients, but it only reached the level of regretting the operation for 3% of them. This occurred more frequently in patients with axillary hyperhidrosis. Ten cases of complications occurred.
  
  
  CONCLUSIONS
  Thoracoscopic sympathectomy provides very good results in most patients, with a very low complication rate. However, the assessment of surgical results using conventional methods is imprecise and inaccurate. Different methodology, including quality of life assessment, must be used for comparing results and providing objective data on the results of this operation.
authors.affiliation: Department of Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil. levleao@dialdata.com.br
authors.forename: Luiz Eduardo Villaça
authors.initials: LE
authors.lastname: Leão
authors.forename: Renato
authors.initials: R
authors.lastname: de Oliveira
authors.forename: Renuzza
authors.initials: R
authors.lastname: Szulc
authors.forename: Jair de Jesus
authors.initials: Jde J
authors.lastname: Mari
authors.forename: Pedro Luis Reis
authors.initials: PL
authors.lastname: Crotti
authors.forename: José Julio Saraiva
authors.initials: JJ
authors.lastname: Gonçalves
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D013562:Sympathectomy / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome