Protecting 2nd Thoracal Sympathetic Ganglion Decrease Compensatory Sweating in Palmar Hyperhidrosis?

Aims: The aim of this retrospecive study was to compare the outcomes of T2 protected and T2 included video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis.

Place and Duration of Study: Department of Thoracic Surgery, Selcuk University Medical Faculty, Research and Educational Hospital, between January 2007 and January 2018.

Methodology: 278 patients were reviewed who got surgical sympathectomy for hyperhydrosis. They were divided into two groups, in first group we transected sympathic chain on level the third rib (T3) and we preserved the sympathic chain on level the second rib (T2), in second group we transected the sympathic chain totally on T2 and T3 level. For all patients blood tests were studied for endocrine diseases such as hyperthyroidism, pheochromocytoma and Cushing’s syndrome. The surgery was performed by opening the parietal pleura, identifying the sympathetic chain and dividing communicating branches using cautery. Postoperative complications were recorded.

Results: The mean follow-up period was 9 months. Most of the patients presented an improvement in palmar hyperhidrosis, without any difference between the groups. The initial satisfaction rate was 97,7% (n=176) in T2 protected group while in T2 included group was 96,9% (n = 95). Postoperatively, compensatory sweating was present in 13 (13,2%) patients of the T2 included group and in 10 (5,5%) patients in the T2 protected group. In addition, compensatory sweating was less severe in the T2 protected patients. There were no mortality or significant postoperative complications in this study.

Conclusion: Both techniques are effective for treating palmar hyperhidrosis, but T2 protected sympathectomy decreases the rate and severity of compensatory sweating.