Analysis of clamping versus cutting of T3 sympathetic nerve for severe palmar hyperhidrosis

Abstract

Objectives: Endoscopic thoracic sympathectomy can predictably eliminate the disabling symptoms of palmar hyperhidrosis. Debate has ensued over competing techniques, in particular, cutting versus clamping of the sympathetic chain. We subjectively assessed the sweat severity in different areas of the body and evaluated changes in the quality of life in patients undergoing either the cutting or clamping technique.

Methods: Patients examined between June 2003 and March 2007 were asked to quantify the severity of their symptoms before and after endoscopic thoracic sympathectomy. The interviews were conducted approximately 1 year after the procedure. Only the patients undergoing sympathectomy at the T3 level for a chief complaint of palmar hyperhidrosis were included in the analysis (n = 152). In 45% of these patients, clamping of the sympathetic chain was performed, and the remaining 55% had the chain cut.

Results: After surgery, no patients had continued excessive sweating of the hands. Of all the patients, 95% were satisfied with the results after the cutting procedure and 97% were satisfied after clamping. No difference was seen in any outcome between the patients undergoing clamping versus cutting of the sympathetic chain, including sweating on the hands, face, armpits, feet, trunk, and thighs or in the quality of life.

Conclusions: We found high rates of success and patient satisfaction when T3 sympathectomy was performed for palmar hyperhidrosis, with no differences found between the cutting and clamping techniques.

Figure 1

Patients were asked to judge the severity of sweating, severity of facial blushing, and quality of life (QOL) at the initial interview and again approximately one year after the operation. The difference between these scores was used as an index of the change, or lack thereof, in symptoms or QOL. For all body regions except the hands, there were variable effects of the surgery - some patients experienced increases, some decreases, and others had no change in symptom severity.