Comparative analysis of T3 selective division of rami communicantes (ramicotomy) to T3 sympathetic clipping in treatment of palmar hyperhidrosis.

Compensatory sweating is a major complaint following endoscopic thoracic sympathetic surgery in treatment of palmar hyperhidrosis. T3 ramicotomy was applied in order to decrease compensatory sweating. From Oct 1999 to June 2002, forty patients underwent T3 sympathetic clipping (group I), and 68 patients underwent T3 ramicotomy (group II) to treat palmar hyperhidrosis. We retrospectively analyzed the rate of satisfaction, result of operation, and grade of compensatory sweating. In group I, 36 patients (90%) showed decreased sweating on both hands, 4 patients (10 %) persistent sweating on both hands. In group II, 46 patients (67.6%) had decreased sweating on both hands, 14 patients (23.5 %) had persistent sweating on both hands, and 8 patients (8.9 %) had persistent sweating in one hand. The rate of satisfaction was 82.5 % (33/40) in group I and 67.6 % (46/68) in group II with no significant statistic difference (p = 0.067). Excluding patients with persistent sweating postoperatively, the rate of compensatory sweating in group II was 67.4%, which was significantly lower than in group I 94.1%, with a p value of 0.003. Although the rate of persisting sweating after operation was high, T3 ramicotomy resulted in lower rate of compensatory sweating compared to T3 sympathetic clipping.