Abstract
Background Hyperhidrosis is a dysfunction of the autonomic nervous system that results in regional
excessive sweating, mostly in the hands, armpits, and feet. A permanent and effective
treatment of hyperhidrosis can be achieved by interruption of the thoracic sympathetic
chain with endoscopic thoracic sympathectomy (ETS). However, some side effects, particularly
compensatory sweating (CS), are the limitations of this procedure. The mechanism of
CS and the associated risk factors are still controversial. The aim of this retrospective
study was to determine the relationship with various parameters associated with CS
in patients undergoing ETS.
Materials and Methods ETS was performed on a total of 95 patients for palmar hyperhidrosis, axillary hyperhidrosis
and facial blushing by the same surgeon. The mean age of the patients was 26.41 (± 7)
years, and 54 (56.8%) were males. Palmar hyperhidrosis was present in 54 (56.8%) patients,
axillary hyperhidrosis in 33 (34.7%) patients, and facial blushing in 8 (8.5%) patients.
Moreover, 38 (40%) patients also had plantar sweating. The severity of CS was rated
into three scales as less, moderate, and severe.
Results Regarding the severity of CS, 55 (57.9%) patients had no or less CS, 28 (29.5%) had
moderate CS, and 12 (12.6%) patients had severe CS. Higher age group had a significant
increased risk of severe CS (p = 0.03) (r = 0.262). Patients with body mass index (BMI) > 25 kg/m2 had a statistically significantly increased risk of severe CS (p = 0.016). Facial blushing resulted in severe CS in a significantly higher proportion
of patients than by palmar and axillary hyperhidrosis (p = 0.001). The level of surgery was another important risk factor for CS, with the
T2 level showing an increased risk of severe CS compared with T3 level (p < 0.001). Furthermore, plantar sweating was inversely and significantly related to
the development of CS. Patients with plantar sweating had a significantly decreased
incidence of developing CS (p = 0.015).
Conclusion CS after thoracic sympathectomy for primary hyperhidrosis is the most displeasing
and restrictive side effect. This study demonstrates that older age, operation level,
facial blushing, and high BMI are risk factors for CS, as have been shown in several
similar studies. An interesting finding of the present study is that there was a decreased
incidence of CS among patients with plantar sweating. This situation may help us to
distinguish high risk for CS before ETS operation.
Keywords
hyperhidrosis - thoracoscopy - palmar hyperhidrosis - compensatory sweating - plantar
sweating - thoracic sympathectomy
