title: Expanded level of sympathetic chain removal does not increase the incidence or severity of compensatory hyperhidrosis after endoscopic thoracic sympathectomy.
abstract: OBJECTIVE
  Compensatory hyperhidrosis is a common devastating adverse effect after endoscopic thoracic sympathectomy for patients undergoing surgical treatment of primary hyperhidrosis. We sought to determine whether a correlation existed in our patient population between the level and extent of sympathetic chain resection and the subsequent development of compensatory hyperhidrosis.
  
  
  METHODS
  All patients undergoing endoscopic thoracic sympathectomy in the T2-T3, T2-T4, T2-T5, or T2-T6 levels for palmar or axillary hyperhidrosis at the University of Iowa Hospital and Clinics (n = 97) from January 2004 to January 2013 were retrospectively reviewed.
  
  
  RESULTS
  Differences in the preoperative patient characteristics were not statistically significant among the patients receiving T2-T3, T2-T4, T2-T5, or T2-T6 level resections. Of the 97 included patients, 28 (29%) experienced transient compensatory hyperhidrosis and 4 (4%) complained of severe compensatory hyperhidrosis and required additional treatment. No operative mortalities occurred, and the morbidity was similar among the groups.
  
  
  CONCLUSIONS
  Most patients had successful outcomes after undergoing extensive resection without changes in the incidence of compensatory hyperhidrosis. Therefore, we recommend performing complete and adequate resection for relief of symptoms in patients with primary hyperhidrosis.
authors.affiliation: Department of Cardiothoracic Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Tyler M
authors.initials: TM
authors.lastname: Gunn
authors.affiliation: Department of Cardiothoracic Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Diane M
authors.initials: DM
authors.lastname: Davis
authors.affiliation: Department of Cardiothoracic Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: James E
authors.initials: JE
authors.lastname: Speicher
authors.affiliation: Department of Cardiothoracic Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Nicholas P
authors.initials: NP
authors.lastname: Rossi
authors.affiliation: Department of Cardiothoracic Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Kalpaj R
authors.initials: KR
authors.lastname: Parekh
authors.affiliation: Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich.
authors.forename: William R
authors.initials: WR
authors.lastname: Lynch
authors.affiliation: Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Brody School of Medicine, Greenville, NC. Electronic address: Iannettonim@ecu.edu.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Iannettoni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006785:Hospitals, University; D006801:Humans; D006945:Hyperhidrosis / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D015994:Incidence; D007484:Iowa / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013546:Sweating; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods*; D013906:Thoracoscopy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult