title: Endoscopic thoracic sympathectomy: long-term results for treatment of upper limb hyperhidrosis and facial blushing.
abstract: BACKGROUND
  Endoscopic thoracic sympthectomy (ETS) is frequently used in the management of patients with hyperhidrosis and excessive blushing. Long term-follow up is scarce. We retrospectively reviewed long-term morbidity, success and overall patient satisfaction rates in patients operated in our department.
  
  
  METHODS
  Data of all patients undergoing ETS for either upper limb hyperhidrosis or facial blushing and sweating between January 1994 and December 2006 were reviewed. A standard questionnaire inquiring on relief of symptoms, satisfaction with the operation and occurrence of compensatory sweating (CS) was sent out in January 2008.
  
  
  RESULTS
  We performed bilateral thoracoscopic sympathectomies in 73 patients. There were no operative mortalities, minor complications occurred in 22%. Initial success rate was 88%. Median follow up was 93 (24-168) months, response rate to the questionnaire was 85%. Sixty-nine per cent of patients continued to have relief of initial symptoms, whereas patient satisfaction rate was 56%. CS was present in 42 patients (68%). Long-term satisfaction rates per initial indication group were 42% for facial blushing and 65% for hyperhidrosis (n.s.), and CS was present in 79% vs 61%, respectively.
  
  
  CONCLUSIONS
  ETS appears a safe treatment for upper limb hyperhydrosis with acceptable long-term results. For excessive blushing, however, long-term satifaction rates of ETS are severely hampered by a high incidence of disturbing compensatory sweating. ETS should only be indicated in patients with unbearable symptoms refractory to non-surgical treatment. The patient information must include the long-term substantial risk for sever CS and regret of the procedure.
authors.affiliation: Department of Vascular Surgery, VU University Medical Center, Amsterdam, The Netherlands. h.coveliers@vumc.nl
authors.forename: H
authors.initials: H
authors.lastname: Coveliers
authors.forename: S
authors.initials: S
authors.lastname: Atif
authors.forename: J
authors.initials: J
authors.lastname: Rauwerda
authors.forename: W
authors.initials: W
authors.lastname: Wisselink
mesh_terms: D000293:Adolescent; D000328:Adult; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005483:Flushing / Q000601:surgery*; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D013562:Sympathectomy / Q000379:methods*; D013900:Thoracic Nerves / Q000601:surgery*; D016896:Treatment Outcome; D034941:Upper Extremity; D055815:Young Adult