title: Thoracoscopic sympathectomy for palmar and axillary hyperhidrosis: four-year outcome and quality of life after bilateral 5-mm dual port approach.
abstract: BACKGROUND
  During recent years, thoracoscopic sympathectomy has been the standard treatment for hyperhidrosis. Different surgical techniques have been described without proving their advantages compared with other procedures. This study was designed to evaluate our modification of thoracoscopic sympathectomy and to compare the effectiveness between axillary and palmar hyperhidrosis.
  
  
  METHODS
  Ninety patients with axillary or palmar hyperhidrosis who underwent bilateral thoracoscopic sympathectomy with single-lumen ventilation with a dual 5-mm port approach were followed up for a median of 3.9 (range, 1-6) years. The clinical course and data during the hospitalization and consultation in our outpatient clinic were reviewed. The following parameters were evaluated: clinical improvement, satisfaction, changes in quality of life, and compensatory sweating and gustatory sweating.
  
  
  RESULTS
  The perioperative mortality was 0, and the morbidity was 6.5%. In 81% clinical improvement of sweating was noticed; 55% did not sweat at all. A total of 88% of patients were satisfied with the result of the operation. The rates of compensatory sweating and gustatory sweating were 93.5% and 49.4%, respectively. The result of sympathectomy in patients with palmar hyperhidrosis were significantly better concerning rate of satisfaction (p = 0.006) and improvement of symptoms (p = 0.027) compared with patients with axillary symptoms. Additionally it was found that the compensatory sweating had significantly impacted the satisfaction rating of the operation.
  
  
  CONCLUSIONS
  Currently different effective surgical approaches for the treatment of hyperhidrosis with improvement rates of more than 80% are available. The quality of the intervention has to be evaluated by changes in quality of life and intensity of compensatory sweating. Thoracoscopic sympathectomy as performed in our institution offers results and complications comparable to previously published trials; however, because of single-lumen ventilation the management is much easier. Therefore, this technique offers an interesting option for the treatment of patients with palmar and axillary hyperhidrosis.
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. k.bachmann@uke.uni-hamburg.de
authors.forename: Kai
authors.initials: K
authors.lastname: Bachmann
authors.forename: Nicola
authors.initials: N
authors.lastname: Standl
authors.forename: Jussuf
authors.initials: J
authors.lastname: Kaifi
authors.forename: Phillip
authors.initials: P
authors.lastname: Busch
authors.forename: Eva
authors.initials: E
authors.lastname: Winkler
authors.forename: Oliver
authors.initials: O
authors.lastname: Mann
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Izbicki
authors.forename: Tim
authors.initials: T
authors.lastname: Strate
mesh_terms: D000293:Adolescent; D000328:Adult; D001365:Axilla; D005260:Female; D005500:Follow-Up Studies; D006225:Hand; D006801:Humans; D006945:Hyperhidrosis / Q000523:psychology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009928:Organ Specificity; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011788:Quality of Life; D012189:Retrospective Studies; D013546:Sweating; D013547:Sweating, Gustatory / Q000209:etiology / Q000503:physiopathology; D013562:Sympathectomy / Q000379:methods* / Q000523:psychology; D013906:Thoracoscopy / Q000379:methods* / Q000523:psychology; D016896:Treatment Outcome; D055815:Young Adult