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Thoracoscopic sympathectomy for palmar hyperhidrosis

Ablate or resect?

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Abstract

Background

Upper thoracoscopic sympathectomy, obtained either by ablation or resection of the appropriate ganglia, is now the preferred treatment for primary palmar hyperhidrosis. Therefore, we undertook a review to compare the relative efficacy of these two techniques.

Methods

A Medline search was performed for the years 1974–99 to identify all published studies of thoracoscopic sympathectomy for hyperhidrosis.

Results

In all, 33 studies were identified and divided into two groups—ablation and resection. When the resection method was used, the immediate success rate was 99.76%, whereas the ablation method achieved dry hands in 95.2% of cases (p=0.00001). Palmar sweating recurred in 0% of patients treated via resection and 0–4.4% treated with ablation. Ptosis was noted in 0.92% of cases after ablation and in 1.72% after resection (p=0.017).

Conclusions

Resection yields superior results, yet the majority of surgeons ablate, probably because it is easier, requires a shorter operating time, leads to fewer cases of Horner’s syndrome, and because resympathectomy eventually overcomes initial failure.

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Authors and Affiliations

  1. Department of Surgery B, The Rambam Medical Center, Technion-Israel Institute of Technology, Post Office Box 9621, 31096, Haifa, Israel

    M. Hashmonai, A. Assalia & D. Kopelman

  2. Faculty of Medicine, Technion-Israel Institute of Technology, Post Office Box 9621, 31096, Haifa, Israel

    M. Hashmonai, A. Assalia & D. Kopelman

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  1. M. Hashmonai
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  2. A. Assalia
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  3. D. Kopelman
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Online publication: 3 April 2001

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Hashmonai, M., Assalia, A. & Kopelman, D. Thoracoscopic sympathectomy for palmar hyperhidrosis. Surg Endosc 15, 435–441 (2001). https://doi.org/10.1007/s004640080042

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