Endoscopic versus transaxillary thoracic sympathectomy for primary axillary and palmar hyperhidrosis and/or facial blushing: 5-year-experience

Abstract

Thoracic sympathectomy is effective in the permanent cure of primaryaxillary and palmar hyperhidrosis and facial blushing, which can be sotroublesome for patients that their social and professional relations canbe affected. Between October 1988 and April 1994, a total of 50 thoracicsympathectomies (10 surgical and 40 endoscopic) were performed on 5 and 23patients, respectively. The operations were performed unilaterally,followed by the contralateral intervention after a period of 6-8 weeks. Thethoracic ganglia T2-T5 were resected for hyperhidrosis. If the patientsuffered from blushing, the lower 1/3 of the stellate ganglion was alsoresected. Postoperatively, all the operated limbs were warm and dry. In thegroup of patients who were operated bilaterally, only one had persistentfacial blushing. The efficacy for blushing in this series was therefore93.3%. The late relapse rate of sympathetic activity was 14.3%.Compensatory sweating was seen in 67%, gustatory sweating in 37.5% andphantom sweating in 29% of the patients. None of them considered these sideeffects to be troublesome. Although there is no difference betweentransaxillary thoracic sympathectomy and the endoscopic intervention interms of efficacy, the latter is associated with less postoperative pain,shorter hospital stay and a rapid recovery. The thoracic sympathectomy isthe treatment of choice for primary hyperhidrosis and excessive facialblushing.