Compensatory sweating following upper thoracic sympathectomy for palmar hyperhidrosis: Can it be avoided?

The aim of this study was to demonstrate that the less sympathetic ganglion is ablated, the less compensatory sweating occurs postoperatively in patients undergoing upper thoracic sympathectomy for palmar hyperhidrosis, without losing the desired palmar anhydrotic effect. During a period of 18 months, 31 patients underwent bilateral thoracoscopic sympathectomy for palmar hyperhidrosis with ablation of a single ganglion in either side: the second thoracic ganglion. No operative or postoperative complications were observed. On follow-up from 1 to 18 months after operation, all patients had an excellent bilateral palmar anhydrotic effect. Only 4 of 31 patients (<13%) had some degree of compensatory sweating on the back and chest without decreasing their overall satisfaction with the procedure. On the basis of these results, the author's initial assumption proved to be correct, since in their previous experience, ganglionectomy of two (T2 + T3) or three (T2 to T4) sympathetic ganglions caused compensatory sweating of various degrees, from 30% to 55% of patients, respectively. Other series describe even higher rates.