Optimal level of sympathectomy for primary palmar Hyperhidrosis: T3 versus T4 in a retrospective Cohort study

• Thoracopscopic sympathectomy is the standard treatment for hyperhidrosis.
• Debates around at which level the ganglia should be blocked.
• We aimed to collect results retrospectively about T3 and T4 sympathectomy.
• How to overcome the compensatory hyperhidrosis and increase patient satisfaction.
• T4 gives these desired results in comparison to T3.

BackgroundTo compare the results obtained with T3 versus T4 sympathectomy in treatment of primary palmar hyperhidrosis (PH).MethodsBy retrospective review of medical records of patients with PH who underwent thoracoscopic sympathectomy from February, 2009 to September, 2012. The patients were categorized into two groups: T3 group underwent T3 sympathectomy and T4 group underwent T4 sympathectomy. Patients were evaluated according to the results of sweating, compensatory hyperhidrosis (CH), degree of satisfaction, complications and recurrence. Mean follow up was 19 ± 7 months.ResultsA total of 274 consecutive patients with PH were included in this study. There were 169 females and 105 males, with mean age of 29 ± 11 years. 129 patients underwent T3 sympathectomy (T3 group). The T4 group included 145 patients who underwent T4 sympathectomy. 71.7% patients of T4 group did not complain of CH in comparison to 25.6% patients in group T3 (P = 0.001) and the incidence of mild to moderate CH was higher in the T3 group than T4 (64.4% vs. 26.9%; p = 0.001). T4 group showed a great significance in the (very satisfied category) in comparison to T3 group (P = 0.001). The incidence of over-dry hands was significantly lower in group T4 (0.7%, 1 out of 145) than in group T3 (8.5%, 11 out of 129). The recurrence rate was similar in the two groups (0.8% vs. 1.4%; P = 0.19).ConclusionVideo-assisted T3 or T4 sympathectomy is a safe and effective procedure for treatment of palmar hyperhidrosis. T4 sympathectomy appears associated with less severe dryness and CH than T3 sympathectomy at long-term follow-up.