Treatment of palmar hyperhidrosis: T(4) level compared with T(3) and T(2).
OBJECTIVE
The aim of this study was to compare the outcomes of 3 different levels of sympathectomy.


BACKGROUND
Most surgeons still perform T(2) or T(2-3) sympathectomy for palmar hyperhidrosis, but both these treatments can cause severe side effects. Some recent articles have advocated T(4) sympathectomy and obtained satisfactory results.


METHODS
Between January 2000 and August 2004, 234 records of patients treated for palmar hyperhidrosis were retrospectively reviewed. Of them, 86 patients were treated with endoscopic thoracic sympathectomy of T(2) (ETS(2)), 78 patients with ETS(3), and 70 patients with ETS(4). Follow-up data were collected using a telephone questionnaire with a scoring system. Multiple linear regressions were used to model markers for degree of satisfaction and severity of compensatory sweating (CS), including descriptive data, level of sympathectomy, clinical outcomes, and postoperative complications.


RESULTS
Mean follow-up was 47.1 +/- 17.2 months. All 3 levels of sympathectomy could have achieved comparable improvement of palmar hyperhidrosis (P = 0.162). However, 88.5% of the patients noticed CS. Patients with ETS(4) presented the lowest incidence of CS (P = 0.030), had the least severity of CS (beta = -1.537, P = 0.002), and felt the least palmar overdryness (P < 0.001). None expressed regret for the procedure in the ETS(4) group (P = 0.022). Being obese did not increase the incidence of CS, but the severity of CS was directly related to body mass index (beta = 0.917, P < 0.001). The patients would be more satisfied if the severity of CS was minimal (beta = -0.185, P = 0.002). The degree of satisfaction may decrease with time (beta = -0.025, P = 0.003) and was lower when their palms were overdry (beta = -1.463, P < 0.001).


CONCLUSIONS
Different from the current procedure of T(2) or T(3) sympathectomy for palmar hyperhidrosis, T(4) sympathectomy would be a better and more effective procedure with minimal long-term complications.
Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Yu-Tang
YT
Chang
Hsien-Pin
HP
Li
Jui-Ying
JY
Lee
Pei-Jung
PJ
Lin
Chien-Chih
CC
Lin
Eing-Long
EL
Kao
Shah-Hwa
SH
Chou
Meei-Feng
MF
Huang
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D008297:Male; D008663:Metacarpus / Q000294:innervation*; D017060:Patient Satisfaction; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013126:Spinal Nerve Roots / Q000601:surgery*; D011795:Surveys and Questionnaires; D013562:Sympathectomy / Q000379:methods*; D013906:Thoracoscopy; D013997:Time Factors; D016896:Treatment Outcome