T3 versus T4 thoracoscopic sympathectomy for palmar hyperhidrosis: a meta-analysis and systematic review.

BACKGROUND

Palmar hyperhidrosis (PH) is a benign sympathetic disorder that can adversely affect the quality of life of patients. Thoracic sympathectomy (TS) at the T3 or T4 level has been used to treat PH. We aimed to determine the optimal denervation level for TS by comparing the efficacy of T3 TS versus T4 TS in PH patients.

METHODS

We searched the PubMed, Ovid MEDLINE, EMBASE, Web of Science, ScienceDirect, the Cochrane Library, Scopus, and Google Scholar databases for studies comparing T3 versus T4 TS for PH. Clinical end points included symptom resolution, patient satisfaction, and complications.

RESULTS

Of 2201 articles reviewed, 10 (T3 group, 566 patients; T4 group, 629 patients) were selected. T4 TS was associated with a lower incidence of postoperative compensatory sweating, dry hands, and gustatory sweating than T3 TS. No significant difference in symptom resolution or patient satisfaction was found between the T3 and T4 groups.

CONCLUSIONS

T4 TS may be superior to T3 TS in patients with PH. However, this finding should be validated in high-quality, large-scale randomized controlled trials.