T3-T5 Thoracoscopic sympathectomy versus sympathicotomy in the treatment of palmar–axillary–plantar hyperhidrosis

Background Compensatory hyperhidrosis is a common complication after thoracoscopic interruption of the sympathetic chain in hyperhidrosis patients. Nonetheless, no interruption technique has been defined to decrease the incidence of that dreadful complication. Herein, we compared T3-5 sympathectomy with sympathicotomy at the same levels with regard to postoperative outcomes. Methods Eighty patients diagnosed with primary palmar–axillary–plantar hyperhidrosis were randomized into two equal groups: the sympathectomy and sympathicotomy groups. They were followed up for 6 months after the procedure. The incidence and criteria of compensatory hyperhidrosis were compared between the two approaches. Results The sympathectomy group showed a significant prolongation of the operative time. However, postoperative pain, hospital stay, and the incidence of complications were statistically comparable between the two approaches. Both procedures were associated with a significant decline in the severity of sweating in the three regions, which was more prominent in the palmar and axillary regions compared with the foot. The incidence of compensatory hyperhidrosis was 65% in sympathectomy patients and 77.5% in sympathicotomy patients, with no significant difference between them (P=0.217). About two-thirds of these cases were temporary, and the majority of them had mild to moderate symptoms. Patient satisfaction did not differ between the two approaches, with poor satisfaction in patients with permanent compensatory hyperhidrosis. Conclusion Both sympathectomy and sympathicotomy had comparable outcomes in patients with palmar–axillary–plantar hyperhidrosis, manifested in comparable decreased sweating severity, incidence of compensatory hyperhidrosis, quality of life, and patient satisfaction.