Bilateral thoracoscopic T2 to T3 sympathectomy versus botulinum injection in palmar hyperhidrosis.
BACKGROUND
Bilateral T2 to T3 thoracoscopic sympathectomy and injection of botulinum toxin-A are presently the most effective modalities in the treatment of primary palmar hyperhidrosis. In this study we evaluated comparative merits of the two therapies.


METHODS
Patients suffering primary palmar hyperhidrosis were treated by either bilateral T2 to T3 thoracoscopic sympathectomy (n = 68) or by injection of botulinum toxin-A (n = 86). The groups were homogeneous for relevant demographic, physiologic, and clinical data. Quantification of sweat production was performed by Minor's iodine starch and glove tests. Subjective changes were assessed by quality of life questionnaires (Hyperhidrosis, Dermatology Life Quality Index, Short Form-36, Nottingham's Health Profile) and patient's satisfaction self-assessment. A cost comparison between groups was also carried out.


RESULTS
No operative mortality or major morbidity was recorded in either group. Minor's test showed a more significant reduction in the surgical group: +94% versus +63% at 6 months and +94% versus +30% at 12 months. Compensatory sweating was significantly greater and long-lasting in the surgical group. All subjective tests improved rapidly and significantly in both groups. After 6 months, results mildly worsened in the surgical group and more significantly in the botulinum group. Patient's satisfaction was initially greater in the botulinum group (p = 0.03), but after 6 months it significantly reversed (p = 0.04). Surgical treatment cost approximately as much as four botulinum treatments.


CONCLUSIONS
Thoracoscopic sympathectomy is superior to botulinum toxin-A injection. The greater initial costs and discomfort are offset by a greater reduction in compensatory sweating.
Ambrogi
Vincenzo
V
Division of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy.
Campione
Elena
E
Mineo
Davide
D
Paternò
Evelin Jasmine
EJ
Pompeo
Eugenio
E
Mineo
Tommaso C
TC
D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006225:Hand; D006801:Humans; D006945:Hyperhidrosis / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D007271:Injections, Intradermal; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011336:Probability; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D012720:Severity of Illness Index; D013562:Sympathectomy / Q000379:methods*; D013904:Thoracic Vertebrae; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
D019274:Botulinum Toxins, Type A