Upper thoracic sympathectomy for primary palmar hyperhidrosis: long-term follow-up

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Abstract
Primary palmar hyperhidrosis is a functionally and socially disabling condition. Upper thoracic sympathectomy is the best curative treatment. Several surgical approaches have been suggested and, recently, less invasive techniques have been communicated. To evaluate which method is the best, the short- and particularly the long-term results must be compared. A series is presented of 170 upper thoracic sympathectomies by the supraclavicular approach performed on 85 patients with palmar hyperhidrosis. Follow-up for a mean of 8·3 years was obtained on 124 operated limbs. The immediate failure rate for relief from hyperhidrosis was 2·4 per cent and hyperhidrosis recurred in another 4·1 per cent of limbs after a period of between 2 and 18 months. Thirteen per cent of patients were dissatisfied with the results of operation, one because of persisting vasomotor rhinitis, two because of Horner's syndrome and five because of persisting or recurrent hyperhidrosis. Satisfactory results in approximately 87 per cent of cases make the operation rewarding. This outcome should be compared with the long-term results of other methods, such as percutaneous phenol injection and the transthoracoscopic approach, when such data are compiled and published.