Comparison of results obtained in the treatment of axillary hyperhidrosis using video-assisted thoracic sympathectomy at denervation levels T3-T4 versus T4

INTRODUCTION: The optimum level of sympathectomy for axillary hyperhidrosis is one that would result in a definitive treatment of hyperhidrosis, associated with a lower severity of compensatory hyperhidrosis. OBJECTIVE: To compare two surgical techniques (denervation levels) of sympathectomy with video-assisted thoracic sympathectomy to treat axillary hyperhidrosis in a period of 12 months. METHODS: From January 2004 to July 2007, 64 patients with axillary hyperhidrosis were randomized for videoassisted thoracic sympathectomy at the T3-T4 or T4 ganglia level; they were followed up for a 12-month period in order to evaluate axillary hyperhidrosis, the incidence and severity of compensatory hyperhidrosis, its evolution throughout the study, and the patients' quality of life. RESULTS: Sixty four patients presented resolution of the axillary hyperhidrosis. No therapeutic failures occurred. After 12 months, 57.6% of the patients of the T4 group and 6. 5% of the T3-T4 group had not developed compensatory hyperhidrosis (p<0.001). Patients of the T4 group who experienced compensatory hyperhidrosis presented a rate lower than those in the T3-T4 group, and no severe CH (p<0.001) was observed. Improvement in the quality of life was reported since the first evaluation, proving to be higher in the T4 group than in the T3-T4 group, starting after six months of follow-up (p=0.002). CONCLUSIONS: Both techniques are effective for treating axillary hyperhidrosis. The most frequent complication was compensatory hyperhidrosis, which remained chronologically stable throughout the study. The T4-level sympathectomy group presented a less severe compensatory hyperhidrosis...