Long-Term Impact of Endoscopic Thoracic Sympathectomy for Primary Palmar Hyperhidrosis.

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The Annals of thoracic surgery


BACKGROUND: Endoscopic thoracic sympathectomy (ETS) is the gold standard treatment for primary hyperhidrosis, with excellent short-term results. The potential for adverse effects, particularly compensatory sweating (CS), may affect long-term satisfaction. In this retrospective review we aimed to examine the long-term results, and quality of life (QOL) following ETS in the management of primary, dominantly palmar hyperhidrosis from a single institution.

METHODS: A review of patients who had undergone ETS for primary palmar or axillary hyperhidrosis between 02/2004-05/2015 was performed. Utilizing a modified questionnaire with validated components, patients were contacted to obtain responses designed to measure outcomes and QOL domains.

RESULTS: Of the 96 eligible patients, 58 (60%) consented and completed the questionnaire. The median time of survey from surgery was 60 months (interquartile range: 35-122). Increased QOL was reported in 84% (49/58) of patients, and increased ability to perform tasks in 86% (50/58). Satisfaction was identified in 97% (56/58) of patients, and 93% (54/58) reported that they would recommend the procedure. CS was reported in 84% (49/58), ranging from minor 78% (38/49) to severe 22% (11/49). There were 146 total CS areas involved, most commonly the back (78%, 38/49). One ETS reversal, for extreme CS, was performed. Nonetheless, 78% (38/49) reported CS to be less disruptive than preoperative hyperhidrosis.

CONCLUSIONS: This study confirms that the benefits of ETS are maintained long-term. Although CS is the main cause for discontent postoperatively, it is still preferred over the distress experienced from palmar or axillary hyperhidrosis and QOL is increased despite CS.