[Endoscopic thoracic sympathectomy for isolated axillary hyperhidrosis].

BACKGROUND: Endoscopic thoracic sympathectomy is accepted as the treatment of choice for palmar hyperhidrosis. But the interest and the results of endoscopic thoracic sympathectomy for isolated axillary hyperhidrosis are still discussed. PATIENTS AND METHODS: In a series of 435 patients operated on for hyperhidrosis of the upper limbs during the 5 past years, 23 were suffering from isolated axillary hyperhidrosis (5.2 p. 100). All patients had been previously treated by local agents and 3 had iontophoresis. All patients underwent a bilateral endoscopic thoracic sympathectomy that was performed in one stage. Sympathectomy was done according to the usual technique but was extended down to T5. All patients were then contacted by phone to answer a detailed questionnaire. Four patients were lost for follow-up. The mean follow-up of the 19 remaining patients was 26 months (ranging 3 to 41 months).
RESULTS: There was no intraoperative or postoperative complication. All patients were discharged the day after surgery. All but one (95 p. 100) were cured from their axillary hyperhidrosis. All of them experienced compensatory sweating (100 p. 100). This compensatory sweating was considered as mild by 8 patients, as embarrassing in 8 and as distressing in 3. Eleven patients complained of excessive dryness of the hands. This was considered as a minor adverse effect by 8 patients and as problematic by 3 patients. Finally, 16 patients were satisfied while 3 claimed they regretted having been operated on.
CONCLUSION: The rate of compensatory sweating and the rate of dissatisfaction are higher after endoscopic thoracic sympathectomy for axillary hyperhidrosis than after endoscopic thoracic sympathectomy for palmar hyperhidrosis. Endoscopic thoracic sympathectomy for axillary hyperhidrosis should be foreseen only when all other therapies have been attempted.