Background: Video assisted thoracic sympathectomy or sympathicotomy is a safe and effective therapy for the treatment of palmar hyperhidrosis with immediate symptomatic improvement. However, the degree of satisfaction may diminish with time due to compensatory sweating or excessive hand dryness. Therefore, by comparing and assessing the degree of symptomatic improvement or compensatory sweating following sympathectomy or sympathicotomy at various levels, we aim to determine the optimal level of sympathetic nerve block which will result in minimal side effects and maximal benefit.
Material and Method: Among 194 patients having undergone video assisted thoracic sympathectomy or sympathicotomy between January, 1996 and June, 1999, 137 patients who responded to either telephone interview or questionnaire were included in the current study. The patients were divided into three groups. Group I(n=61); patients having undergone T2,3,4 sympathectomy, group II(35); patients having undergone T2 sympathicotomy, and group III(41); patients having undergone limited T2 sympathicotomy which consist of block of interganglionic neuronal fiber on the third rib. The parameters studied comprised of pre- and post-operative palmar temperature change, treatment satisfaction, the degree of compensatory sweating or discomfort from palmar dryness, postoperative complication, and changes in plantar sweating.
Result: There was no difference in age and sex among the groups, and the mean postoperative elevation in palmar temperature was 2.59℃ without any differences among the groups. Patients expressing satisfaction were 65.6%, 62.9%, and 90.24% in groups I, II, and III, respectively(p<0.05). Moderate to severe compensatory sweating was present in 65.6%, 51.4%, and 24.39% in groups I, II, and III, respectively(p<0.05). Slight but comfortable amount of palmar humidness was expressed in decreasing order group III(41.6%), group I(24.6%), and group II(5.7%)(p<0.05). Ineffectiveness or recurrence was present in 5patients in group I(8.2%), 1 patient in group II(2.9%) and none in group III. With regards to plantar sweating, decrease in sweating was expressed in 43 patients (31.4%), while similar degree of sweating in 61 patients (44.5%), and increase in sweating in another 33 patients (24.1%).
Conclusion: Limited T2 sympathicotomy, resection of the lower interganglionic neuronal fiber of the second sympathetic ganglion on the third rib, showed immediate effect in palmar hyperhidrosis and caused lesser compensatory sweating and hand dryness.
(Korean Thorac Cardiovasc Surg 2000;33:817-22)

Keywords: Hyperhidrosis, Sympathicotomy