title: Twenty months of evolution following sympathectomy on patients with palmar hyperhidrosis: sympathectomy at the T3 level is better than at the T2 level.
abstract: OBJECTIVE
  To compare two surgical techniques (denervation levels) for sympathectomy using video-assisted thoracoscopy to treat palmar hyperhidrosis in the long-term.
  
  
  METHODS
  From May 2003 to June 2006, 60 patients with palmar hyperhidrosis were prospectively randomized for video-assisted thoracoscopic sympathectomy at the T2 or T3 ganglion level. They were followed for a mean of 20 months and were evaluated regarding their degree of improvement of palmar hyperhidrosis, incidence and severity of compensatory hyperhidrosis and its evolution over time, and quality of life.
  
  
  RESULTS
  Fifty-nine cases presented resolution of the palmar hyperhidrosis. One case of therapeutic failure occurred in the T3 group. Most of the patients presented an improvement in palmar hyperhidrosis, without any difference between the groups. Twenty months later, all patients in both groups presented some degree of compensatory hyperhidrosis but with less severity in the T3 group (p = 0.007). Compensatory hyperhidrosis developed in most patients during the first month after the operation, with incidence and severity that remained stable over time. An improvement in quality of life was seen starting from the first postoperative evaluation but without any difference between the groups. This improvement was maintained until the end of the follow-up.
  
  
  CONCLUSIONS
  Both techniques were effective for treating palmar hyperhidrosis. The most frequent complication was compensatory hyperhidrosis, which presented stable incidence and severity over the study period. Sympathectomy at the T3 level presented compensatory hyperhidrosis with less severity. Nevertheless, the improvement in quality of life was similar between the groups.
authors.affiliation: Department of Vascular Surgery, Hospital das Clínicas, Faculdade de Medicinada Universidade de São Paulo, São Paulo/SP, Brazil. guilhermeyazbek@yahoo.com
authors.forename: Guilherme
authors.initials: G
authors.lastname: Yazbek
authors.forename: Nelson
authors.initials: N
authors.lastname: Wolosker
authors.forename: Paulo
authors.initials: P
authors.lastname: Kauffman
authors.forename: José Ribas Milanez de
authors.initials: JR
authors.lastname: Campos
authors.forename: Pedro
authors.initials: P
authors.lastname: Puech-Leão
authors.forename: Fábio Biscegli
authors.initials: FB
authors.lastname: Jatene
mesh_terms: D004812:Epidemiologic Methods; D005260:Female; D006225:Hand / Q000601:surgery*; D006801:Humans; D006945:Hyperhidrosis / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D008297:Male; D011788:Quality of Life; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted; D013904:Thoracic Vertebrae; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
references.citation: Ann Thorac Surg. 1997 Oct;64(4):975-8
references.pmid: 9354512
references.citation: Clin Auton Res. 2005 Apr;15(2):116-20
references.pmid: 15834768
references.citation: J Neurosurg. 1979 Jan;50(1):88-94
references.pmid: 758384
references.citation: J Am Coll Surg. 2007 Mar;204(3):435-8
references.pmid: 17324778
references.citation: J Am Acad Dermatol. 1995 Jul;33(1):78-81
references.pmid: 7601951
references.citation: Eur J Cardiothorac Surg. 2008 May;33(5):786-9
references.pmid: 18375139
references.citation: World J Surg. 2008 Nov;32(11):2343-56
references.pmid: 18797962
references.citation: Ann Chir Gynaecol. 2001;90(3):161-6
references.pmid: 11695784
references.citation: J Laparoendosc Adv Surg Tech A. 2008 Feb;18(1):102-6
references.pmid: 18266585
references.citation: Clin Anat. 2004 May;17(4):294-9
references.pmid: 15108332
references.citation: Clinics (Sao Paulo). 2008 Dec;63(6):771-4
references.pmid: 19060999
references.citation: J Neurosurg Spine. 2005 Feb;2(2):151-4
references.pmid: 15739526
references.citation: J Pediatr Surg. 1993 Jul;28(7):909-11
references.pmid: 8229566
references.citation: J Vasc Surg. 2002 Feb;35(2):382-6
references.pmid: 11854739
references.citation: Neurosurgery. 1997 Jul;41(1):110-3; discussion 113-5
references.pmid: 9218302
references.citation: Surg Laparosc Endosc Percutan Tech. 2006 Aug;16(4):222-5
references.pmid: 16921300
references.citation: Surg Neurol. 1999 Nov;52(5):453-7
references.pmid: 10595764
references.citation: Ann Thorac Surg. 2007 May;83(5):1850-3; discussion 1853
references.pmid: 17462412
references.citation: Hawaii Med J. 2001 May;60(5):126, 137
references.pmid: 11432050
references.citation: Surg Gynecol Obstet. 1993 Feb;176(2):151-4
references.pmid: 8421803
references.citation: Ann Thorac Surg. 2003 Sep;76(3):886-91
references.pmid: 12963223
references.citation: Isr J Psychiatry Relat Sci. 2000;37(1):25-31
references.pmid: 10857268
references.citation: Ann Acad Med Singap. 1996 Sep;25(5):673-8
references.pmid: 8924003
references.citation: AMB Rev Assoc Med Bras. 1978 Jan;24(1):29-30
references.pmid: 305592
references.citation: J Vasc Surg. 2003 Jan;37(1):124-8
references.pmid: 12514588
references.citation: J Neurosurg. 2003 Jul;99(1 Suppl):39-43
references.pmid: 12859057
references.citation: Arch Surg. 2001 Oct;136(10):1115-7
references.pmid: 11585501
references.citation: J Vasc Surg. 2005 Aug;42(2):281-5
references.pmid: 16102627
references.citation: J Bras Pneumol. 2007 May-Jun;33(3):248-54
references.pmid: 17906784
references.citation: Surg Endosc. 2007 Oct;21(10):1768-71
references.pmid: 17404794
references.citation: Sao Paulo Med J. 2003 Sep 1;121(5):191-7
references.pmid: 14666290
references.citation: Ann Surg. 1938 Jan;107(1):25-31
references.pmid: 17857114
references.citation: Br J Surg. 1990 Sep;77(9):1046-9
references.pmid: 2131796
references.citation: Surg Endosc. 2001 Oct;15(10):1159-62
references.pmid: 11727092
references.citation: J Thorac Cardiovasc Surg. 2002 Mar;123(3):498-501
references.pmid: 11882821