title: An analysis of the natural course of compensatory sweating following thoracoscopic sympathectomy.
abstract: BACKGROUND
  To evaluate the long-term results of thoracoscopic sympathectomy in the treatment of hyperhydrosis.
  
  
  METHODS
  Theatre log books were used to identify all patients who underwent thoracoscopic sympathectomy between 2000 and 2006. Details of pre-operative symptoms, surgical procedure and post-operative complications were collected from the patient notes. Each patient was sent a questionnaire regarding success of the procedure, compensatory sweating and overall satisfaction.
  
  
  RESULTS
  46 hyperhydrosis patients (34 females) age range 14-57 years. 20 patients suffered with hyperhydrosis in a combination of areas, 14 in the axillae alone, 9 palms alone and with 2 facial symptoms. There were 2 early post-operative complications, 1 haemothorax which required a chest drain and a chest infection. 3 patients required redo procedures. Of follow-up of 42 months (range 6-84), 32 (69·5%) patients reported complete dryness or a significant improvement in symptoms and 15 a substantial improvement in quality of life. However 43 patients (93%) suffered with compensatory sweating, of these 27 had to change clothes more than once daily. Compensatory sweating was graded as severe in 18 and incapacitating in 2. Of note only 5 patients noticed an improvement in the compensatory sweating over time. Only 26 (56%) would recommend thoracoscopic sympathectomy to others with hyperhydrosis.
  
  
  CONCLUSIONS
  Thoracoscopic sympathectomy is effective in the treatment of hyperhydrosis. However compensatory sweating seems unavoidable and infrequently improves with time. Patients need to be carefully counselled before committing to surgery.
authors.affiliation: Department of Surgery, Division of Surgery and Cancer, Imperial College, London W2 1NY, United Kingdom.
authors.forename: A C
authors.initials: AC
authors.lastname: Currie
authors.forename: J R
authors.initials: JR
authors.lastname: Evans
authors.forename: P R S
authors.initials: PR
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D007367:Intercostal Nerves / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013546:Sweating / Q000502:physiology*; D013562:Sympathectomy / Q000009:adverse effects* / Q000379:methods; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome; D055815:Young Adult