Tehran University Medical Journal

Background: Hyperhydrosis, excessive sweating, can profoundly affect the quality of life of the patient, with severe impairment of daily activities, social relationships and occupational activities. The purpose of this study was to evaluate the outcome of thoracoscopic sympathectomy in patients with palmar hyperhydrosis.

Methods: In a clinical trial at Imam Khomeini, Milad and Velenjak Hospitals from 2003 to 2006, 33 patients older than five years of age with palmar hyperhydrosis underwent thoracoscopic sympathectomy of T₂ and T₃ ganglions. The variables regarding operation duration, length of hospital stay and early post-op complications were recorded. In addition, the quality of life of the patients was evaluated using the DLQI questionnaire, while the satisfaction of the patients was evaluated using the visual analogue scale before, immediately after and six months after the operation.

Results: The mean age of the patients was 23 years and 63.6% of our patients were female. The sites of hyperhydrosis were hand, foot and armpit in 72.7% of the patients. In 90.91% of the cases, disease onset occurred during childhood and 78.79% of the patients had a family history of hyperhydrosis. Hyperhydrosis impaired function and had social, interpersonal and emotional effects in 72.7% of the cases. The mean duration of the operation was 40.3 minutes and the mean hospital stay was 1.45 days. The most common early post-op complications were atelectasis (7.57%), short-term pulmonary complications (3.03%) and pleural effusion (3.03%). Compensatory hyperhydrosis occurred in 60% of the cases, while 18.75% experienced gustatory sweating. Palms were reported to be totally dry immediately after and six months after the operation in 81.82% of the cases, while 18.18% reported acceptable levels of perspiration. The mean level of satisfaction immediately after and six months after the procedure was 0.81. All patients felt improvement in all aspects of their lives immediately after and six months after the operation. In terms of quality of life, the mean of DLQI score was significantly lower immediately after and six months after operation (18.78 ± 501 vs. 1.60 ± 0.81 and 1.64 ± 1), indicating that symptoms had less effect on the patients' lives. All patients were willing to re-experience the operation if necessary.

Conclusion: Thoracoscopic sympathectomy is an effective and safe therapeutic modality for palmar hyperhydrosis with a great rate of success and a slight chance of complica-tions. This operation results in a remarkable improvement in various aspects of the patients' lives. Willingness to re-experience the operation indicates the high degree of satisfaction.