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EFFECT OF SYMPATHECTOMY LEVEL ON THE INDICDENCE OF COMPENSATORY HYPERHIDROSIS AFTER SYMPATHECTOMY FOR PALMAR HYPERHIDROSIS
D. L. Miller, A. S. Bryant, S. D. Force, J. I. Miller. Emory Unversity School of Medicine, Atlanta, GA,
BACKGROUND: Palmar hyperhidrosis can be psychosocially unacceptable. A significant number of individuals do not undergo sympathectomy because of the fear of compensatory hyperhidrosis (CH). Controversy exists as to the level and the number of levels treated that affect the incidence of CH in patients who undergo sympathectomy for palmar hyperhidrosis.
METHODS: Retrospective review of a VATS database consisting of all patients who had VATS sympathectomy for palmer hyperhidrosis at a single institution.
RESULTS: VATS sympathectomy was performed in 282 patients for palmer hyperhidrosis from May 2002 through July 2005; 179 patients (64%) underwent division at the T2 level only and 103 patients at T2, T3, and T4 levels. The two groups were similar for median age and gender. The rate for CH was significantly less in the T2 group (23 patients - 13%) than in T2-4 group (24 patients - 24%), respectively (p = 0.026). The most common site of compensatory hyperhidrosis was the lower back for both groups. Patients with CH were older (median age 31 years versus 23 years (p = 0.037), had a BMI greater than 27 (p=0.048), and had sympathectomy at multiple levels (p=0.004).
CONCLUSIONS: Compensatory hyperhidrosis continues to occur after sympathectomy for palmar hyperhidrosis. However, a significant reduction in compensatory hyperhidrosis can be achieved by dividing the sympathetic chain at a single level (T2). Patients who are older and have increased BMIs should possibly undergo a temporary sympathectic block to determine if CH would be a significant side effect before a permanent sympathectomy.
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