title: Thoracoscopic sympathectomy for hyperhidrosis: indications and results.
abstract: BACKGROUND
  Hyperhidrosis can cause significant professional and social handicaps. Although treatments such as oral medication, botox, and iontophoresis are available, surgical sympathectomy is being increasingly utilized.
  
  
  METHODS
  Between January 1997 and December 2002, 180 patients with palmar, axillary, facial, or plantar hyperhidrosis underwent a thoracoscopic sympathectomy. Surgical technique evolved during our study period and included excision of the sympathetic ganglia at T(2), T(3), or T(4) depending on the location of the sweating using monopolar cautery.
  
  
  RESULTS
  Patient demographics included 33% males (59/180) and 67% females (121/180), with a mean age of 29.2 years old (range 12 to 76 years old). Ethnic origin was 67% white (122/180), 19% Asian (34/180), 8% Black (14/180), and 6% Hispanic (10/180). Positive family history of hyperhidrosis was noted in 57%. Preoperatively, 49% patients (86/180) had palmar sweating only, 7% patients (12/180) axillary only, 24% patients (43/180) palmar and axillary, 16% patients (28/180) face/scalp only, and 7% patients (11/180) all of the above; additionally 69% patients (125/180) had plantar hyperhidrosis. All procedures were performed through 3-mm and 5-mm ports, and 98% (177/180) were completed as an outpatient procedure. Complications included a mild temporary Horner's Syndrome (n = 1; 0.5%), air leak requiring chest drainage (n = 9; 5%), and bleeding (n = 3; 1.6%) requiring thoracoscopic reexploration (n = 1) and chest drainage (n = 2). Success rates were palmar 100% (109/109), axillary 98% (48/49), and face/scalp 93% (26/28). Plantar hyperhidrosis responded with improvement in 82% (72/88) of all patients. Seventy-eight percent patients (96/123) experienced compensatory hyperhidrosis, usually affecting the stomach, chest, back, and neck. Overall satisfaction was 94% (139/148).
  
  
  CONCLUSIONS
  Thoracoscopic sympathectomy is a safe and effective outpatient method for managing hyperhidrosis. Although overall satisfaction is high, patients should be fully informed about the potential for compensatory sweating.
authors.affiliation: University of Texas Southwestern Medical Center at Dallas, CRSTI, Medical City Hospital, Dallas, Texas, USA. nsdoolabh@aol.com
authors.forename: Neelan
authors.initials: N
authors.lastname: Doolabh
authors.forename: Shannon
authors.initials: S
authors.lastname: Horswell
authors.forename: Mary
authors.initials: M
authors.lastname: Williams
authors.forename: Lynne
authors.initials: L
authors.lastname: Huber
authors.forename: Syma
authors.initials: S
authors.lastname: Prince
authors.forename: Dan M
authors.initials: DM
authors.lastname: Meyer
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006945:Hyperhidrosis / Q000235:genetics / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D013562:Sympathectomy / Q000295:instrumentation*; D020708:Thoracoscopes