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    • Bilateral Thoracoscopic Sympathectomy for Primary Palmar Hyperhidrosis, Which Level: T3 or T4?

    Wadie Boshra MD, MRCS, Abdallah Hamed Ibrahim Khalil MD, Fawzy Salah Fawzy MD, MRCS
    Department of General Surgery, Ain Shams University, Cairo, Egypt.

    Background: Primary palmar hyperhidrosis (PPH) is an extremely disabling condition that affects the patients’ quality of life. Thoracoscopic sympathectomy (TS) is a highly safe & effective modality of treatment and compensatory sweating (CS) is the most common unavoidable side effect. There is still a debate regarding the optimal number & level of sympathetic ganglia to be targeted. Aim: This study aimed to compare T3 & T4 ganglionectomy regarding efficacy, complications, side effects & patients’ satisfaction. Patients & Methods: Forty patients with PPH were divided into 2 groups 20 patients each: group A underwent bilateral TS at T3 level & group B at T4 level. Efficacy, complications, side effects & patients’ satisfaction were compared among both groups. Results: Thoracoscopy related complications were mild & self limiting. Both levels were equally effective (100%) with no recurrence after one year. CS occurred in 95% in T3 group & in 60% in T4 group (significant) and severe CS occurred in 20% in T3 & in 5% in T4 (insignificant). Hands over-dryness occurred in 10% in T3 & in 0% in T4 (insignificant). Gustatory sweating occurred in 15% in T3 & in 0% in T4 (insignificant). Marked satisfaction was 20% in T3 & in 60% in T4 (significant). Overall satisfaction & dissatisfaction were 75 % & 10% in T3 and 90% & 0% in T4 respectively (both insignificant). Conclusion: PPH can be effectively treated by either T3 or T4 TS, with high rates of patient satisfaction. T4 TS appears to be superior to T3 as it is associated with less severe CS & higher patients’ satisfaction rates and should be the denervation level of choice. However, this finding should be validated in high-quality, large-scale randomized controlled trials. Key words: Primary hyperhidrosis, Palmar, Thoracoscopic Sympathectomy, Compensatory Sweating. 

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