Abstract
To assess and compare the long-term results of upper dorsal sympathetic ganglionectomy (UDS) and endoscopic thoracic sympathectomy (ETS), we examined 84 patients who underwent UDS and 71 patients who underwent ETS for the treatment of palmar hyperhidrosis. The period of follow-up ranged from 37 to 228 months. The immediate success rate was 100% in the UDS group and 98.6% in the ETS group. Troublesome compensatory hyperhidrosis occurred in 67.8% of the UDS patients and 84.8% of the ETS patients; however, 55% of the UDS patients and 63% of the ETS patients felt satisfied with their operation. The main reasons for dissatisfaction were recurrence and compensatory hyperhidrosis. Interestingly, simultaneous cure of plantar hyperhidrosis occurred in 28 (40%) of the UDS patients and 28 (44%) of the ETS patients with concomitant plantar hyperhidrosis. ETS required both a shorter operation time and hospital stay than UDS. Thus, we now perform ETS as the treatment of choice because of its excellent illumination and adequate magnification via a minimally invasive approach. The use of ETS as the first choice of treatment for palmar hyperhidrosis is supported not only by the immediate results, complications, and cure of plantar hyperhidrosis, but also by the long-term results. Nevertheless, compensatory hyperhidrosis was also a major complication after ETS.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Kao MC, Lin JY, Chen YL, Hsieh CS, Cheng LCJ, Huang SJ (1996) Minimally invasive surgery: video endoscopic thoracic sympathectomy for palmar hyperhidrosis. Ann Acad Med Singapore 25:673–678
Shachor D, Jedeikin R, Olstanger D, Bendahan J, Sivak G, Freund U (1994) Endoscopic transthoracic sympathectomy in the treatment of primary hyperhidrosis. Arch Surg 129:241–244
Lin CC (1992) Extended thoracoscopic T2-sympathectomy in treatment of hyperhidrosis: experience with 130 consecutive cases. J Laparoendosc Surg 2:1–5
Hsu CP, Chen CY, Lin CT, Wang JH, Chen CL, Wang PY (1994) Video-assisted thoracoscopic T2 sympathectomy for hyperhidrosis palmaris. J Am Coll Surg 178:59–64
Byrne J, Walsh TN, Hederman WP (1990) Endoscopic transthoracic electrocautery of the sympathetic chain for palmar and axillary hyperhidrosis. Br J Surg 77:1046–1049
Herbst F, Plas EG, Függer R, Fritsch A (1994) Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs: a critical analysis and long-term results of 480 operations. Ann Surg 1:86–90
Chou SH, Lee SH, Kao EL (1993) Thoracic endoscopic T2-T3 sympathectomy in palmar hyperhidrosis: experience of 112 cases. Jpn J Surg 23:105–107
Lai YT, Yang LH, Chio CC, Chen HH (1997) Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy. Neurosurgery 41:110–115
Edmondson RA, Banerjee AK, Rennie JA (1992) Endoscopic transthoracic sympathectomy in the treatment of hyperhidrosis. Ann Surg 215:289–293
Guttmann L (1940) Distribution of disturbances of sweat secretion after extirpation of certain sympathetic cervical ganglion in man. J Anat 74:537–549
O’Riordain DS, Maher M, Waldron DJ, O’Donovan B, Brady MP (1993) Limiting the anatomic extent of upper thoracic sympathectomy for primary palmar hyperhidrosis. Surg Gynecol Obstet 176:151–154
Howng SL, Loh JK (1987) Long term follow up of upper dorsal sympathetic ganglionectomy for palmar hyperhidrosis—a scale of evaluation. Kaohsiung J Med Sci 3:703–707
Adson AW, Craig WM, Brown GE (1935) Essential hyperhidrosis cured by sympathetic ganglionectomy and trunk resection. Arch Surg 31:794–806
Adar R, Kurchin A, Zweig A, Mozes M (1977) Palmar hyperhidrosis and its surgical treatment. Ann Surg 186:34–41
Greenhalgh RM, Rosengarten DS, Matin P (1971) Role of sympathectomy for hyperhidrosis. Br Med J 1:332–334
Ellis H (1975) Hyperhidrosis and its surgical treatment. Postgrad Med 53:191–196
Cloward RB (1969) Hyperhidrosis. J Neurosurg 30:545–551
Kux M (1978) Thoracic endoscopic sympathectomy in palmar and axillary hyperhidrosis. Arch Surg 113:264–266
Golueke PJ, Garrett WV, Thompson JE, Talkington CM, Smith BL (1988) Dorsal sympathectomy for hyperhidrosis—the posterior paravertebral approach. Surgery 103:568–572
Bass A, Inovrotzlavski S, Adar R (1983) Upper dorsal sympathectomy for pllmar hyperhidrosis. Isr J Med Sci 19:112–115
Shih CJ, Wang YC (1978) Thoracic sympathectomy for palmar hyperhidrosis: report of 457 cases. Surg Neurol 10:291–296
Lin CC, Mo LR (1996) Experience in thoracoscopic sympathectomy for hyperhidrosis with concomitant pleural adhesion. J Surg Laparosc Endosc 6:258–261
Shelley WB, Florence R (1960) Compensatory hyperhidrosis after sympathectomy. N Engl J Med 263:1056–1058
Bogokowsky H, Slutski S, Bacalu L, Abramsohn R, Negri M (1983) Surgical treatment of primary hyperhidrosis—a report of 42 cases. Arch Surg 118:1065–1067
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lin, CL., Yen, CP. & Howng, SL. The long-term results of upper dorsal sympathetic ganglionectomy and endoscopic thoracic sympathectomy for palmar hyperhidrosis. Surg Today 29, 209–213 (1999). https://doi.org/10.1007/BF02483008
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02483008