Transection of more than one sympathetic chain ganglion for hyperhidrosis increases the severity of compensatory hyperhidrosis and decreases patient satisfaction

Abstract

Sympathectomy (ETS) is an effective treatment for hyperhidrosis (HH), but compensatory hyperhidrosis (CH) is a common side effect. We reviewed our experience with 200 patients. Two hundred patients were retrospectively analyzed. Patients completed a questionnaire regarding their postoperative symptoms [% improvement score (IS), CH score], and their level of dissatisfaction, which was assessed as a function of regretting the choice to undergo ETS. Significance set at P< or =0.05. There were 123 (61.5%) females. Mean age was 28.2+/-7.4. Follow-up (mo) was 20.9+/-12.1. One ganglion was transected in 112 (56%) patients (G1), and more than one in 88 (G2). Overall, 157 (78.5%) patients had CH, 88 (74.1%) patients in G1 and 74 (84.1%) in G2, P=0.06. Patients in G2 had a higher CH score (4.1+/-2.7 versus 3.0+/-2.5, P<0.01), and a higher number of patients regretting surgery (11.4% versus 3.6%, P=0.05). Multivariate analysis showed age, high CH score, and surgery on T2 as independent predictors of patient's dissatisfaction (P<0.05). Patients with more than one ganglion transected demonstrate a trend toward a higher incidence of CH, a significantly higher CH score, and are more dissatisfied with ETS. Age, surgery on T2, and high CH score are independent predictors of patient's dissatisfaction.