title: Reoperative endoscopic sympathectomy for persistent or recurrent palmar hyperhidrosis.
abstract: BACKGROUND
  Sympathectomy for severe palmar hyperhidrosis occasionally fails. This investigation reviews our experience with reoperative thoracoscopic sympathectomy (RS) for patients with persistent or recurrent palmar hyperhidrosis after sympathectomy.
  
  
  METHODS
  A retrospective analysis of patients undergoing RS for palmar hyperhidrosis was conducted. Comparison was made with all patients undergoing an initial thoracoscopic sympathectomy (TS) for palmar hyperhidrosis at our institution during the same period.
  
  
  RESULTS
  Over 6 years, 40 patients underwent bilateral (32) or unilateral (8) RS for refractory (35) or recurrent (5) palmar hyperhidrosis. During the same period, 321 patients underwent bilateral TS for palmar hyperhidrosis. Previous methods of sympathectomy included percutaneous ablation (25), TS (10), axillary thoracotomy (3), and a posterior transthoracic approach (2). Twenty-two RS patients and 11 TS patients required a third port to complete the procedure because of pleural adhesions (p = 0.0001). Twenty-three RS and 11 TS patients required postoperative pleural drainage (p = 0.0004). Mean length of stay was1.6 for the RS group and less than 1 day for the TS group (p = 0.0001). Alleviation of palmar hyperhidrosis occurred in 38 RS patients and 316 TS patients (p = 0.18). Compensatory sweating was identified in 21 RS patients and 101 TS patients (p = 0.01).
  
  
  CONCLUSIONS
  Reoperative thoracoscopic sympathectomy produced a rate of improvement comparable to that of TS. However, RS was associated with an increased need for postoperative pleural drainage, longer hospital stay, a more difficult operative procedure, and a higher rate of compensatory sweating than TS was. Reoperative sympathectomy should be considered a safe and effective option for patients with palmar hyperhidrosis who remain severely symptomatic after a sympathectomy.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, St Vincent Hospital, Indianapolis, Indiana, USA. rfreeman@corvascmds.com
authors.forename: Richard K
authors.initials: RK
authors.lastname: Freeman
authors.forename: Jaclyn M
authors.initials: JM
authors.lastname: Van Woerkom
authors.forename: Amy
authors.initials: A
authors.lastname: Vyverberg
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Ascioti
mesh_terms: D000328:Adult; D004724:Endoscopy; D005260:Female; D006225:Hand; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013562:Sympathectomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult