title: Thoracoscopic sympathectomy for hyperhidrosis: analysis of 642 procedures with special attention to Horner's syndrome and compensatory hyperhidrosis.
abstract: BACKGROUND
  Hyperhidrosis (HH) profoundly affects a patient's well-being.
  
  
  OBJECTIVE
  We report indications and outcomes of 322 patients treated for HH via thoracoscopic sympathectomy or sympathotomy at the Barrow Neurological Institute.
  
  
  METHODS
  A prospectively maintained database of all patients who underwent sympathectomy or sympathotomy between 1996 and 2008 was examined. Additional follow-up was obtained in clinic, by phone, or by written questionnaire.
  
  
  RESULTS
  A total of 322 patients (218 female patients) had thoracoscopic treatment (mean age 27.6 years; range, 10-60 years). Mean follow-up was 8 months. Presentations included HH of the palms (43 patients, 13.4%), axillae (13 patients, 4.0%), craniofacial region (4 patients, 1.2%), or some combination (262 patients, 81.4%). Sympathectomy and sympathotomy were equally effective in relieving HH. Palmar HH resolved in 99.7% of patients. Axillary or craniofacial HH resolved or improved in 89.1% and 100% of cases, respectively. Hospital stay averaged 0.5 days. Ablating the sympathetic chain at T5 increased the incidence of severe compensatory sweating (P = .0078). Sympathectomy was associated with a significantly higher incidence of Horner's syndrome compared with sympathotomy (5% vs 0.9%, P = .0319). Patients reported satisfaction and willingness to undergo the procedure again in 98.1% of cases.
  
  
  CONCLUSIONS
  Thoracoscopic sympathectomy is effective and safe treatment for severe palmar, axillary, and craniofacial HH. Ablating the T5 ganglion tends to increase the severity of compensatory sweating. Sympathectomy led to a higher incidence of ipsilateral Horner's syndrome compared with sympathotomy.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Wait
authors.forename: Brendan D
authors.initials: BD
authors.lastname: Killory
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Lekovic
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Ponce
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Kenny
authors.forename: Curtis A
authors.initials: CA
authors.lastname: Dickman
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005728:Ganglia, Sympathetic / Q000503:physiopathology / Q000601:surgery*; D015171:Ganglionectomy / Q000379:methods*; D006732:Horner Syndrome / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D006945:Hyperhidrosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013562:Sympathectomy / Q000379:methods*; D013906:Thoracoscopy / Q000379:methods*; D055815:Young Adult