title: Video assisted thoracoscopic re-sympathetic surgery in the treatment of re-sweating hyperhidrosis.
abstract: OBJECTIVE
  The characteristics and causes of re-sweating after sympathetic surgery in hyperhidrosis patients have yet to be clearly documented due primarily to low incidence of re-sympathetic surgery. The purpose of this study is to identify the causes of re-sweating following sympathetic surgery, and to assess the outcomes of re-sympathetic surgery.
  
  
  METHODS
  From February 1997 to July 2003, 36 patients underwent re-sympathetic surgery in order to treat re-sweating. Patients originally underwent sympathetic surgery due to facial (14 cases), palmar (21 cases), and axillary (1 case) hyperhidrosis.
  
  
  RESULTS
  Sympathectomy was performed as a primary surgical intervention in 7 cases (19.4%), sympathicotomy in 12 cases (33.3%), and sympathetic clipping in 17 cases (47.3%). Thirteen patients complained of re-sweating on both sides, and 23 patients exhibited unilateral re-sweating. The onset of re-sweating occurred after an average of 3.1+/-3.4 months (range, 1-12 months) after the operation. The causes of re-sweating after sympathetic surgery included an intact sympathetic chain in 4 cases (11.1%), incomplete resection in 6 cases (16.7%), partial reattachment in 6 cases (16.7%), improper ganglion location in 4 cases (11.1%), clip slipping out in 11 cases (30.5%), and unknown in 5 cases (13.9%). Twenty-seven patients (75.0%) exhibited re-sweating within 3 months, and 9 patients (25.0%) experienced re-sweating after 6 months. During the second operation, sympathicotomy was performed in 20 cases (55.6%) and sympathetic clipping in 16 cases (44.4%) in which 32 patients (88.9%) reported decreased sweating.
  
  
  CONCLUSIONS
  Surgical errors during the initial operation constituted the main cause of re-sweating following sympathetic surgery. Re-sympathetic surgery was necessary in order to treat re-sweating, and was associated with favorable outcomes.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital, Daejeon, South Korea.
authors.forename: Do Hyung
authors.initials: DH
authors.lastname: Kim
authors.forename: Hyo Chae
authors.initials: HC
authors.lastname: Paik
authors.forename: Doo Yun
authors.initials: DY
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D001365:Axilla; D005145:Face; D005260:Female; D005500:Follow-Up Studies; D006225:Hand; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D008297:Male; D019300:Medical Errors; D008875:Middle Aged; D017060:Patient Satisfaction; D012008:Recurrence; D012086:Reoperation; D013525:Surgical Instruments; D013562:Sympathectomy / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted; D017211:Treatment Failure