Video-assisted thoracoscopic sympathetic surgery is currently a worldwide accepted treatment of primary upper extremity hyperhidrosis. Compensatory hyperhidrosis is the most common late complication and appeared to correlate with the extent and number of levels of sympathicotomy performed. In patients with combined severe palmar and axillary symptoms, the surgeon must decide whether to divide the chain at multiple levels by combining what is done for palmar and axillary symptoms alone (T2-T3-T4) or simply choose which of the two operations to perform based on which symptom predominates.
Between December 2012 and October 2015, 103 patients with severe combined palmar, axillary and plantar hyperhidrosis underwent to thoracoscopic T2-T3 sympathicotomy.
Target resolution of the disorder in long term follow-up was achieved in 100% (hands), 97.08% (axilla), and 58.25% (foot-through unknown mechanism) of the patients. Long term reduction in plantar sweating was 29.12% and in axillary sweating was 2.9%. Mild to moderate compensatory sweating occurred in 10 patients (9.7%). The long term recurrence rate was 2.9% (axilla), 17.8% (foot) and 0% (hands). The recurrence in axilla and foot was in the form of mild dry. Overall satisfaction rate was 99.02%.
In conclusion, our results suggest that T2-T3 video-assisted thoracoscopic sympathicotomy is a safe and effective procedure for treatment of combined palmar, axillary and plantar hyperhidrosis.