Unilevel (T3) versus Bilevel (T3 – T4) Sympathictomy in the Management of Palmar Hyperhidrosis; Does It Affect the Incidence and Severity of Postoperative Compensatory Sweating?

Abstract Background: Thoracoscopic sympathicotomy (TS) has emerged as the prevailing surgical approach for primary palmar hyperhidrosis (PH) due to its minimally invasive nature causing minimum morbidity and minimal stress. Compensatory hyper-hidrosis (CH) is the most frequent and troubling complication following TS, and numerous strategies have been proposed to prevent its onset. This work aimed to compare T3 with T3-4 TS in the management of patients with PH regarding the incidence of postoperative CH. Patients and Methods: This randomized study included 50 patients aged >18 years old, diagnosed with primary PH and scheduled for TS. The allocated patients were as signed into two groups; group A underwent only T3 sympathicotomy and group B underwent T3-4 sympathicotomy. Results: Operative time reduced significantly in group A than in group B (19.6±4.31 vs 24.2±5.53min, p=0.002). In-cidence and degree of postoperative CH were insignificantly different at 1m, 3m, and 6m between both groups. The inci-dence of postoperative axillary sweating was significantly low-er in group B than group A at 1m (13 (52.0%) vs 21 (84.0%), p=0.032) and 3m (8 (32.0%) vs 17 (68.0%), p=0.011) and was comparable at 6m between both groups. The numerical rating scale measurements at 0h, 2h, 4h, 8h, 12h, 20h, and 24h, hospital stay, patient satisfaction, pneumo-thorax, subcutaneous emphysema, and recurrence were compa-rable between both groups. None of the patients in either group had hemothorax.
Conclusions: Both the bilevel (T3 – T4) and unilevel (T3) approaches were safe and effective for treating patients with PH with comparable incidence of CH while postoperative axillary sweating was more prevalent in the unilevel (T3) group mak-ingbilevel more suitable for patients with axillary sweating.