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Review
. 2025 Jun;35(3):353-364.
doi: 10.1007/s10286-025-01115-x. Epub 2025 Feb 5.

Comparison of the effectiveness and safety between ramicotomy and sympathetic chain interruption in the treatment of primary hyperhidrosis: a meta-analysis

Sheng Yong #  1   2 , Xiaotong Yang #  1 , Wei Cao  1   2 , Weirun Min  1   2 , Yunjiu Gou  3
Affiliations
Review

Comparison of the effectiveness and safety between ramicotomy and sympathetic chain interruption in the treatment of primary hyperhidrosis: a meta-analysis

Sheng Yong et al. Clin Auton Res. 2025 Jun.

Abstract

Objective: This meta-analysis evaluates the effectiveness and safety of ramicotomy versus sympathetic chain interruption (SCI) in treating primary hyperhidrosis (PH).

Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, Web of Science, Ovid, Cochrane Library, CNKI, and Wanfang, covering studies from their inception through October 2024. A total of 10 studies involving 970 patients were included, with 504 patients undergoing ramicotomy and 466 receiving SCI.

Results: The analysis revealed that patients undergoing ramicotomy experienced significantly lower rates of compensatory hyperhidrosis (CH) [odds ratio (OR) 0.41, 95% confidence interval (CI) 0.20-0.85, P = 0.02], severe CH (OR 0.17, 95% CI 0.06, 0.47, P < 0.001), and postoperative hand dryness (OR 0.10, 95% CI 0.01-0.72, P = 0.02), along with a higher recurrence rate (OR 4.03, 95% CI 2.38, 6.85, P < 0.001). No significant differences were observed in operative duration [mean difference (MD) = 0.19, 95% CI -18.23, 18.60, P = 0.98 > 0.05], length of hospital stay (MD = -0.08, 95% CI -0.19, 0.04, P = 0.20 > 0.05), total postoperative complications (OR 0.41, 95% CI 0.07, 2.34, P = 0.32 > 0.05), or surgical satisfaction (OR 0.93, 95% CI 0.45, 1.91, P = 0.83 > 0.05).

Conclusions: While ramicotomy results in lower incidences of CH and postoperative hand dryness, its higher recurrence rate suggests that its application should be cautious to manage PH effectively.

Keywords: Compensatory hyperhidrosis; Meta-analysis; Primary hyperhidrosis; Ramicotomy; Sympathetic chain interruption.

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Conflict of interest statement

Declarations. Conflict of interest: “The authors declare that they have no competing interests.”

References

    1. Abdel-Aziz M, Abdelhafez Mahmoud M, Daboos M, Abdelmaboud M, Akl M, Mahfouz M, Salama A, Ashour Y, Mohamed Y, Hussien M, Azab A, Magid M (2024) Fifteen years’ experience of thoracoscopic sympathetic chain interruption for palmar hyperhidrosis in children and adolescents: evaluation of different techniques. J Laparoendosc Adv Surg Tech A. https://doi.org/10.1089/lap.2024.0026 - DOI - PubMed
    1. Adorisio O, Davoli E, Ceriati E, Battaglia S, Camanni D, De Peppo F (2022) Effectiveness of unilateral sequential video-assisted sympathetic chain blockage for primary palmar hyperidrosis in children and adolescents. Front Pediatr 10:1067141. https://doi.org/10.3389/fped.2022.1067141 - DOI - PubMed - PMC
    1. Akil A, Semik M, Fischer S (2019) Efficacy of miniuniportal video-assisted thoracoscopic selective sympathectomy (ramicotomy) for the treatment of severe palmar and axillar hyperhidrosis. Thorac Cardiovasc Surg 67:415–419. https://doi.org/10.1055/s-0038-1642030 - DOI - PubMed
    1. Alkosha HM, Abuelnasr T, Mohammed M (2022) Efficacy and outcome prediction of unilateral video-assisted thoracoscopic sympathectomy in primary palmar hyperhidrosis: a comparative study with bilateral sympathectomy. World Neurosurg 161:e308–e318. https://doi.org/10.1016/j.wneu.2022.02.005 - DOI - PubMed
    1. Alkosha HM, Mohammed MIR, Abuelnasr T, Amen MM (2023) Predictors of compensatory sweating following video-assisted thoracoscopic sympathectomy in primary palmar hyperhidrosis. World Neurosurg. https://doi.org/10.1016/j.wneu.2023.06.085 - DOI - PubMed

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