Treatment of Palmar Hyperhidrosis

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Abstract
Objective: The aim of this study was to compare the outcomes of 3 different levels of sympathectomy. Summary Background Data: Most surgeons still perform T2 or T2–3 sympathectomy for palmar hyperhidrosis, but both these treatments can cause severe side effects. Some recent articles have advocated T4 sympathectomy and obtained satisfactory results. Methods: Between January 2000 and August 2004, 234 records of patients treated for palmar hyperhidrosis were retrospectively reviewed. Of them, 86 patients were treated with endoscopic thoracic sympathectomy of T2 (ETS2), 78 patients with ETS3, and 70 patients with ETS4. Follow-up data were collected using a telephone questionnaire with a scoring system. Multiple linear regressions were used to model markers for degree of satisfaction and severity of compensatory sweating (CS), including descriptive data, level of sympathectomy, clinical outcomes, and postoperative complications. Results: Mean follow-up was 47.1 ± 17.2 months. All 3 levels of sympathectomy could have achieved comparable improvement of palmar hyperhidrosis (P = 0.162). However, 88.5% of the patients noticed CS. Patients with ETS4 presented the lowest incidence of CS (P = 0.030), had the least severity of CS (β = −1.537, P = 0.002), and felt the least palmar overdryness (P < 0.001). None expressed regret for the procedure in the ETS4 group (P = 0.022). Being obese did not increase the incidence of CS, but the severity of CS was directly related to body mass index (β = 0.917, P < 0.001). The patients would be more satisfied if the severity of CS was minimal (β = −0.185, P = 0.002). The degree of satisfaction may decrease with time (β = −0.025, P = 0.003) and was lower when their palms were overdry (β = −1.463, P < 0.001). Conclusions: Different from the current procedure of T2 or T3 sympathectomy for palmar hyperhidrosis, T4 sympathectomy would be a better and more effective procedure with minimal long-term complications.