What outcomes have been reported for endoscopic sympathectomy to treat axillary hyperhidrosis?

Updated: Feb 12, 2019
  • Author: Richard H S Karpinski, MD, FACS; Chief Editor: Gregory Gary Caputy, MD, PhD, FICS  more...
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Herbst et al studied 323 patients nearly 15 years after endoscopic thoracic sympathectomy and summarized their results as follows:

There was no postoperative mortality and no major complications requiring surgical reintervention. A majority of the patients (98.1%) were relieved, and 95.5% were satisfied initially. Permanent side effects included compensatory sweating in 67.4%, gustatory sweating in 50.7% and Horner's triad in 2.5%. However, patient satisfaction declined over time, although only 1.5% recurred. This left only 66.7% satisfied, and 26.7% partially satisfied. Compensatory and gustatory sweating were the most frequently stated reasons for dissatisfaction. Individuals operated for axillary hyperhidrosis without palmar involvement were significantly less satisfied (33.3% and 46.2%, respectively). [22]

Sympathetic regeneration has been documented in animals and humans and may result in late recurrence of hyperhidrotic symptoms. In animals, sympathetic fibers have remarkable regenerative ability, with regrowth and reinnervation through muscle and scar over time.

To achieve axillary anhidrosis, more extensive and/or more caudal resection of the sympathetic chain has been advocated, but this also seems to increase the chances of compensatory sweating and cardiovascular dysautonomia.

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