Treatment of palmoplantar hyperhidrosis by video-assisted thoracoscopic sympathectomy: third versus fourth thoracic ganglion

INTRODUCTION: Currently, video-assisted thoracic sympathectomy has become the preferred treatment for palmar hyperhidrosis. The main side effect after surgery remains compensatory hyperhidrosis (CH), considered the major cause of dissatisfaction for patients. OBJECTIVE: To compare the results obtained of video-assisted sympathectomy performed on two distinct ganglion levels (third versus fourth thoracic ganglion) in the treatment of palmo-plantar hyperhidrosis, through a blind randomized clinical trial. METHOD: We selected 40 patients from February 2007 to May 2009. All participants were randomized into two groups of 20 patients (G3 and G4) and underwent the operation, being followed for 12 months (1 week, 1 month, 6 months and 12th month). We used an objective method for measuring sweat, checking the "TEWL (transepidermal water loss) measured by the"VapoMeter", and evaluated the quality of life before and after the operation. Also studied were: palmar hyperhidrosis, incidence and intensity of the CH. RESULTS: All patients ceased suffering from palmar hyperhidrosis after surgery, with statistical difference regarding the time factor when we compared the values of "TEWL" palmar preoperatively with their respective values at 1 week, 1 month, 6 months and 12th month. The main side effect observed was compensatory sweating, most frequent in G3 after 12 months of follow-up; despite this, there was no statistical difference regarding the intensity (severity) of CH in both groups. There was an improvement in quality of life since the first evaluation of the postoperative period, with no difference between groups, and so it remained until the end of follow-up. The areas most affected by CH were back, chest, abdomen and thighs; however, there was no statistical difference in the "TEWL" measured in these areas after 12 months of follow-up. CONCLUSION: Both techniques were effective in the treatment of palmar hyperhidrosis, generating objective reduction of "TEWL" regardless of the ganglion operated. Sympathectomy G3 had a higher incidence of CH, yet the improvement in quality of life was similar in both groups without significant differences of "TEWL" quantified on the back, abdomen, thighs and legs after 12 months of follow up