Background: Palmar hyperhidrosis is a frustrating condition both physically and psychologically. Presently, endoscopic thoracic sympathectomy (ETS) is the treatment of choice for palmar and axillary hyperhidrosis. In this study, we assessed a total of 530 ETS operations carried out for palmar hyperhidrosis, together with long-term outcomes.

Methods: We retrospectively analyzed 530 ETS operations performed in 368 patients (363 males, 5 females; mean age 22 years; range 20 to 33 years). Forty-two patients underwent one-stage bilateral sympathectomy, and 326 patients underwent unilateral sympathectomy or two-staged bilateral sympathectomy. Endoscopic resection of the T2-3 ganglion using the two-port technique and cauterization of the Kuntz nerve were performed. The patients were evaluated with respect to the surgical technique, complications seen during or after the operation, and satisfaction. Patients were followed-up for an average of 34.6 months (range 4 to 89 months).

Results: Early or late operative mortality did not occur. A total of 86 patients had complications with an overall morbidity rate of 23.3%. Seventy-two patients developed compensatory sweating in various parts of the body. Nine patients (2.4%) developed Horner’s syndrome. Operative morbidity rate was 3.2% when compensatory sweating and recurrences were excluded. Two recurrences were observed in the longterm follow-up. A total of 359 patients were fully satisfied with the operation, five patients declared partial satisfaction, whereas three patients expressed dissatisfaction.

Conclusion: Endoscopic thoracic sympathectomy should be the choice of treatment in palmar hyperhidrosis due to lower operative morbidity rates and higher postoperative satisfaction. We think that this operation can be performed safely and aesthetically with the aid of two thoracoports.

Keywords : Endoscopy; ganglionectomy/methods; hand; hyperhidrosis/ surgery; patient satisfaction; sweating; sympathectomy