Long-term results of 630 thoracoscopic sympathicotomies for primary hyperhidrosis: the Vienna experience.

OBJECTIVE

To evaluate of the results of thoracoscopic sympathicotomy for upper limb hyperhidrosis with a median observation period of more than 15 years.

DESIGN

Retrospective clinical observation study.

SETTING

University-affiliated tertiary referral centre.

SUBJECTS: 630 consecutive operations in 352 patients (median age 30.1 yrs) for primary palmar (68%), axillary (12.7%) and combined hyperhidrosis (19.3%).

INTERVENTIONS: Thoracoscopic sympathicotomy from below T1 to T4 including the fibres of Kuntz using electrocautery through single site access.

MAIN OUTCOME MEASURES: Perioperative success and complication rates (all patients); long-term follow-up by a questionnaire and/or clinical examination (83.3% of patients) after a median period of 16 yrs. Calculation of statistical significance of differences between groups with c2-test.

RESULTS

67.8% of patients were fully satisfied, 25.7% were partially satisfied and would again agree to the operation. In 93% the procedure cured hyperhidrosis permanently. Compensatory and gustatory sweating was observed in 67% and 47% of cases, respectively. Overall success was significantly (p < 0.001) lower in the group with axillary hyperhidrosis. Main complications: drainage for pneumothorax 1.3%, Horner's syndrome in 3.8%, subcutaneous emphysema 2.1%.

CONCLUSION

Thoracoscopic sympathicotomy proved to be highly effective even after long-term follow-up. Compensatory sweating impairs patients' satisfaction in some cases.