Unilateral versus Bilateral T3 Ganglionectomy in Primary Palmar Hyperhidrosis Patients

Abstract

Background

Primary palmar hyperhidrosis (PPH) causes excessive hand sweating, impacting daily activities and quality of life. Endoscopic thoracic sympathectomy (ETS), including ganglionectomy, is a common treatment, but the risk of compensatory hyperhidrosis (CH) remains a concern. This study compares unilateral versus bilateral T3 ganglionectomy, focusing on differences in CH occurrence and patient satisfaction.

Methods

We retrospectively analyzed 118 patients who underwent either unilateral or bilateral T3 ganglionectomy for PPH at our institution from November 2023 to January 2025. Data on patient characteristics and surgical outcomes were extracted from electronic medical records. Patient satisfaction and incidence of CH were assessed at postoperative 3 months.

Results

Of the 118 patients with severe PPH, 77 underwent bilateral T3 ganglionectomy, and 41 received unilateral T3 ganglionectomy. No significant differences in baseline characteristics were observed between the groups. Postoperative satisfaction was higher in the unilateral group, with 93% reporting being “very satisfied” compared with 61% in the bilateral group (p < 0.001). The unilateral group also had fewer incidences of CH, with 80% reporting no CH, while 43% of the bilateral group experienced mild CH (p = 0.007). The most common areas affected by CH were the back, thighs, chest, abdomen, and hips. In the unilateral group, 7.5% showed improvement in contralateral sweating, with 22% necessitating contralateral ganglionectomy.

Conclusion

This study is the first to compare the effectiveness and incidence of CH between unilateral and bilateral ETS for PPH. Our results show that 93% of unilateral ETS patients reported high satisfaction, compared with 61% in the bilateral group. Eighty percent of the unilateral group experienced no CH, while only 43% in the bilateral group reported mild CH. Statistically significant differences were observed in both satisfaction scores (p < 0.001) and CH occurrence (p = 0.007), suggesting unilateral ETS may provide better symptom relief with fewer adverse effects. Compared with prior studies, our cohort showed improved bilateral ETS outcomes, with only 48% developing CH. These findings indicate that unilateral ETS may be preferred for patients seeking higher satisfaction and reduced risk of CH, though further long-term studies are needed to confirm such results.

Keywords

hyperhidrosis - minimally invasive surgery (includes port access - minithoracotomy) - practice guidelines - quality of life

Authors' Contribution

All the authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Publikationsverlauf

Eingereicht: 09. Juli 2025

Angenommen: 04. September 2025

Accepted Manuscript online:
11. September 2025

Artikel online veröffentlicht:
28. September 2025

• References

• 1 Woo W, Kim BJ, Kang DY, Won J, Moon DH, Lee S. Patient experience and prognostic factors of compensatory hyperhidrosis and recurrence after endoscopic thoracic sympathicotomy. Surg Endosc 2022; 36 (11) 8340-8348
• 2 Chwajol M, Barrenechea IJ, Chakraborty S, Lesser JB, Connery CP, Perin NI. Impact of compensatory hyperhidrosis on patient satisfaction after endoscopic thoracic sympathectomy. Neurosurgery 2009; 64 (03) 511-518 , discussion 518
• 3 Loizzi D, Mongiello D, Bevilacqua MT. et al. Surgical management of compensatory sweating: A systematic review. Front Surg 2023; 10: 1160827
• 4 Wolosker N, Milanez de Campos JR, Fukuda JM. Management of Compensatory Sweating After Sympathetic Surgery. Thorac Surg Clin 2016; 26 (04) 445-451
• 5 Raveglia F, Orlandi R, Guttadauro A. et al. How to prevent, reduce, and treat severe post sympathetic chain compensatory hyperhidrosis: 2021 State of the Art. Front Surg 2022; 8: 814916
• 6 Du X, Zhu X, Wang T. et al. Compensatory hyperhidrosis after different surgeries at the same sympathetic levels: a meta-analysis. Ann Transl Med 2018; 6 (11) 203
• 7 Ehrhardt JD, Weber C, Carey FJ. et al. Anatomy, thorax, greater splanchnic nerves. Updated January 31, 2024. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;
• 8 Adorisio O, Davoli E, Ceriati E, Battaglia S, Camanni D, De Peppo F. Effectiveness of unilateral sequential video-assisted sympathetic chain blockage for primary palmar hyperidrosis in children and adolescents. Front Pediatr 2022; 10: 1067141
• 9 Araújo CA, Azevedo IM, Ferreira MA, Ferreira HP, Dantas JL, Medeiros AC. Compensatory sweating after thoracoscopic sympathectomy: characteristics, prevalence and influence on patient satisfaction. J Bras Pneumol 2009; 35 (03) 213-220
• 10 Licht PB, Pilegaard HK. Severity of compensatory sweating after thoracoscopic sympathectomy. Ann Thorac Surg 2004; 78 (02) 427-431