Introduction: Endoscopic thoracic sympathectomy has been accepted as the most effective treatment for palmar hyperhidrosis (PH). The present study was done to compare the results achieved by electrocautery transection and clipping with special attention to compensatory sweating. Methods: This prospective randomized study was conducted in Ain Shams University Hospitals from September 2014 to February 2017 and included 16 patients with primary palmar hyperhidrosis. They were randomized into 2 groups; each of 8 patients. In group A; the sympathetic chains with T2 and T3 ganglia were clipped on both sides and in group B, the sympathetic chains and ganglia were ablated bilaterally using electro-coagulation diathermy hook. Results: Highly significant rate of CS in group A versus group B (62% VS 37%) with P value 0.004. Conclusion: Both clipping and cauterization are highly effective for the treatment of PH but clipping had the higher incidence of CS which mostly mild to moderate and theoretically can be reversed. Disclosure: This article is not sponsored by any company, so the authors have no competing interests as defined by Nature Publishing Group, or other interests that might be perceived to influence the results and/or discussion reported in this article. Key words: Clipping, Transection, Sympathectomy, Compensatory Sweating.