Long-term results of 630 thoracoscopic sympathicotomies for primary hyperhidrosis: the vienna experience

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Abstract
Objective: To evaluate of the results of thoracoscopic sympathicotomy for upper limb hyperhidrosis with a median observation period of more than 15 years. Design: Retrospective clinical observation study. Setting: University‐affiliated tertiary referral centre. Subjects: 630 consecutive operations in 352 patients (median age 30.1 yrs) for primary palmar (68%), axillary (12.7%) and combined hyperhidrosis (19.3%). Interventions: Thoracoscopic sympathicotomy from below T1 to T4 including the fibres of Kuntz using electrocautery through single site access. Main outcome measures: Perioperative success and complication rates (all patients); long‐term follow‐up by a questionnaire and/or clinical examination (83.3% of patients) after a median period of 16 yrs. Calculation of statistical significance of differences between groups with c2‐test. Results: 67.8% of patients were fully satisfied, 25.7% were partially satisfied and would again agree to the operation. In 93% the procedure cured hyperhidrosis permanently. Compensatory and gustatory sweating was observed in 67% and 47% of cases, respectively. Overall success was significantly (p < 0.001) lower in the group with axillary hyperhidrosis. Main complications: drainage for pneumothorax 1.3%, Horner's syndrome in 3.8%, subcutaneous emphysema 2.1%. Conclusion: Thoracoscopic sympathicotomy proved to be highly effective even after long‐term follow‐up. Compensatory sweating impairs patients' satisfaction in some cases. Copyright © 1998 Taylor and Francis Ltd.

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