title: Optimal level of sympathectomy for primary palmar hyperhidrosis: T3 versus T4 in a retrospective cohort study.
abstract: BACKGROUND
  To compare the results obtained with T3 versus T4 sympathectomy in treatment of primary palmar hyperhidrosis (PH).
  
  
  METHODS
  By retrospective review of medical records of patients with PH who underwent thoracoscopic sympathectomy from February, 2009 to September, 2012. The patients were categorized into two groups: T3 group underwent T3 sympathectomy and T4 group underwent T4 sympathectomy. Patients were evaluated according to the results of sweating, compensatory hyperhidrosis (CH), degree of satisfaction, complications and recurrence. Mean follow up was 19 ± 7 months.
  
  
  RESULTS
  A total of 274 consecutive patients with PH were included in this study. There were 169 females and 105 males, with mean age of 29 ± 11 years. 129 patients underwent T3 sympathectomy (T3 group). The T4 group included 145 patients who underwent T4 sympathectomy. 71.7% patients of T4 group did not complain of CH in comparison to 25.6% patients in group T3 (P = 0.001) and the incidence of mild to moderate CH was higher in the T3 group than T4 (64.4% vs. 26.9%; p = 0.001). T4 group showed a great significance in the (very satisfied category) in comparison to T3 group (P = 0.001). The incidence of over-dry hands was significantly lower in group T4 (0.7%, 1 out of 145) than in group T3 (8.5%, 11 out of 129). The recurrence rate was similar in the two groups (0.8% vs. 1.4%; P = 0.19).
  
  
  CONCLUSIONS
  Video-assisted T3 or T4 sympathectomy is a safe and effective procedure for treatment of palmar hyperhidrosis. T4 sympathectomy appears associated with less severe dryness and CH than T3 sympathectomy at long-term follow-up.
authors.affiliation: Department of General Surgery, Faculty of Medicine, Mansoura University Hospital, El Gomhoria Street, Mansoura, Egypt. Electronic address: surg_latif@hotmail.com.
authors.forename: Mohamed E
authors.initials: ME
authors.lastname: Abd Ellatif
authors.affiliation: Department of General Surgery, Faculty of Medicine, Mansoura University Hospital, El Gomhoria Street, Mansoura, Egypt.
authors.forename: Amro El
authors.initials: AE
authors.lastname: Hadidi
authors.affiliation: Islamic University, Khartoum, Sudan.
authors.forename: Adil M
authors.initials: AM
authors.lastname: Musa
authors.affiliation: Department of General Surgery, Faculty of Medicine, Mansoura University Hospital, El Gomhoria Street, Mansoura, Egypt.
authors.forename: Walid
authors.initials: W
authors.lastname: Askar
authors.affiliation: Department of General Surgery, Faculty of Medicine, Mansoura University Hospital, El Gomhoria Street, Mansoura, Egypt.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Abbas
authors.affiliation: Department of General Surgery, Faculty of Medicine, Mansoura University Hospital, El Gomhoria Street, Mansoura, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Negm
authors.affiliation: Department of General Surgery, Faculty of Medicine, Mansoura University Hospital, El Gomhoria Street, Mansoura, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Moatamed
authors.affiliation: Department of General Surgery, Faculty of Medicine, Mansoura University Hospital, El Gomhoria Street, Mansoura, Egypt.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Dawoud
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006225:Hand; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D008297:Male; D017060:Patient Satisfaction; D012008:Recurrence; D012189:Retrospective Studies; D013562:Sympathectomy / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome; D055815:Young Adult
keywords: Compensatory; Hyperhidrosis; Satisfaction; Sympathectomy; Thoracoscopy