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. 2024 Nov 20;16(11):e74077.
doi: 10.7759/cureus.74077. eCollection 2024 Nov.

Comparing Compensatory Sweating After Video-Assisted Thoracoscopic Sympathectomy: (T2-3) Versus (T2-4) Levels for Treating Palmar Hyperhidrosis

Peter Guirguis  1 , Mina Girgis  1 , Walid Abu Arab  1 , Samir Keshk  1 , Abdel-Meguid Ramadan  1
Affiliations

Comparing Compensatory Sweating After Video-Assisted Thoracoscopic Sympathectomy: (T2-3) Versus (T2-4) Levels for Treating Palmar Hyperhidrosis

Peter Guirguis et al. Cureus. .

Abstract

Introduction: Primary hyperhidrosis is a disease that is characterized by excessive sweating beyond what is required to maintain the normal temperature of the body. Moreover, it has a great adverse effect on the life of the affected persons because of problems in their social lives. There are different modalities to treat primary hyperhidrosis, including medical and surgical treatment. However, in sympathectomy, there is still a lack of strong evidence regarding which level should be targeted to achieve maximum benefit with fewer complications.

Methods: This prospective clinical study was conducted at the Cardiothoracic Surgery Department, Alexandria Main University Hospital, Alexandria, Egypt, from September 2021 to Jan 2022. The study involved a total of 50 eligible consecutive patients who had bilateral primary palmar hyperhidrosis managed by bilateral, bi-portal, and tubeless thoracoscopic approach with conventional general anesthesia. Group A represents 25 patients with 13 males (52%) who had sympathetic chain cutting at the level of T2-3, and group B represents 25 patients with 15 males (60%) who had sympathetic chain cutting at the level of T2-4. The effect on palmar hyperhidrosis, compensatory hyperhidrosis, and overall patient satisfaction was assessed on the Visual Analog Scale (VAS).

Result: Ninety-eight percent of patients in both groups showed postoperative complete dryness of the hand and improvement of their symptoms. There was a statistically significant (p<0.001) difference regarding the degree of severity of compensatory sweating post-operatively between both groups. In group A, 44% of patients had compensatory sweating, while in group B, 96% of patients had symptoms of compensatory sweating with varying degrees from 1 to 5 on a VAS-Score of five degrees.

Conclusion: The level of cauterization has no significant effect on palmar hyperhidrosis dryness after cutting the sympathetic chain at level (T2-3) vs. (T2-4). However, the greater the number of levels that are cauterized, which are three levels rather than two, the more severe the compensatory sweating in this study.

Keywords: compensatory sweating; hyperhidrosis; sympathectomy; thoracic surgery; video-assisted thoracoscopic surgery (vats).

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Faculty of Medicine, Alexandria University issued approval 00012098. The study has been accepted according to the ethical standards of scientific research. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

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