Category: Sympathectomy

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Compensatory Hyperhidrosis After ETS: Temporal Evolution and Predictors

Thorac Cardiovasc Surg. 2026 Feb 24. doi: 10.1055/a-2819-1705. Online ahead of print.

ABSTRACT

BACKGROUND: Compensatory hyperhidrosis remains the most significant complication after endoscopic thoracic sympathectomy for primary palmar hyperhidrosis. However, its temporal evolution and long-term predictors are not fully elucidated.

METHODS: This multicentre retrospective study included 226 patients who underwent bilateral clip-based ETS between 2009 and 2023. Patients were stratified by surgical level: R3 (n=60), R4 (n=72), R2-R4 (n=81), and asymmetric interruption (n=13). Compensatory hyperhidrosis severity was assessed at 6, 12 months, and final follow-up (mean 98 months). Logistic regression identified independent predictors of Compensatory hyperhidrosis, recurrence, and patient satisfaction.

RESULTS: Complete palmar dryness was achieved in 84.5% of patients. Compensatory hyperhidrosis occurred in 48.7%, exclusively within the first 6 postoperative months, with no late-onset cases. During long-term follow-up, spontaneous regression of compensatory hyperhidrosis was observed in 28.2% of affected patients. Compensatory hyperhidrosis incidence differed significantly across surgical levels (p=0.011): 38.3% (R3), 55.6% (R4), 63.0% (R2-R4), and 30.8% (asymmetric). Multivariate analysis confirmed multi-level R2-R4 sympathectomy as an independent predictor of compensatory hyperhidrosis (OR=2.18, p=0.042), while single-level R4 interruption provided the lowest persistent compensatory hyperhidrosis burden. Overall satisfaction was 79.6%, and recurrence-not compensatory hyperhidrosis -was the main determinant of dissatisfaction (OR=2.48, p<0.001). Smoking history independently predicted recurrence (OR=2.09, p=0.042).

CONCLUSIONS: Compensatory hyperhidrosis develops exclusively during the early postoperative period and shows partial spontaneous improvement over time. Multi-level interruption significantly increases compensatory hyperhidrosis risk without improving efficacy, supporting limited single-level approaches (preferably R4). These findings emphasize the importance of surgical level selection, smoking cessation, and realistic postoperative counseling.

PMID:41734813 | DOI:10.1055/a-2819-1705

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A significant gap between inadequate pharmacotherapy and substantial unmet needs in palmar hyperhidrosis management in China: insights from a questionnaire-based survey among outpatients

Front Pharmacol. 2026 Jan 8;16:1715189. doi: 10.3389/fphar.2025.1715189. eCollection 2025.

ABSTRACT

BACKGROUND: Palmar hyperhidrosis, characterized by excessive sweating primarily affecting the hands, significantly impairs quality of life and psychological well-being. Although topical agents, iontophoresis, microwave therapy, and sympathectomy are established interventions, real-world treatment patterns and pharmacotherapeutic adequacy among Chinese patients remain poorly delineated.

METHODS: An anonymous, questionnaire-based survey was conducted among consecutive patients at a tertiary thoracic surgery clinic in China between March 2023 and October 2024. A total of 363 valid responses were collected and analyzed using SPSS 27.0. Descriptive statistics and multivariable logistic regression were used to evaluate treatment patterns, patient preference, and predictors of treatment selection.

RESULTS: The study cohort was composed predominantly of individuals with severe disease (87.3% HDSS grade 3-4), and nearly all participants (97.8%) presented with palmar hyperhidrosis. Regarding treatment history, only 38.1% had previously received pharmacotherapy, while 32.6% had utilized Traditional Chinese Medicine (TCM) therapeutic approaches, including TCM, acupuncture, massage and manipulation therapies. Antiperspirants (28.6%) and TCM (25.0%) were the most frequently used prior pharmacotherapies, yet both were associated with limited therapeutic efficacy. According to our survey, owing to high symptom severity, 52.9% had a general knowledge of surgical intervention before the outpatient visit. Primary concerns regarding previous pharmacotherapy included insufficient efficacy and localized adverse effects, particularly skin irritation. Notably, 50.0% of participants remained receptive to future pharmacotherapy, showing a preference for topical formulations (29.3%) and reduced dosing frequency (31.6%). Gender and disease severity were identified as significant determinants of treatment choice. Importantly, prior negative experiences – such as inefficacy and side effects – did not significantly diminish willingness to consider future pharmacologic treatment.

CONCLUSION: Inadequate management and suboptimal treatment outcomes represent considerable challenges in the care of palmar hyperhidrosis in China. Existing pharmacotherapeutic options are constrained by limited availability, inadequate efficacy, and a narrow range of approved agents – a reality that highlights a critical disconnect with substantial patient demand. These findings underscore an urgent need to accelerate drug development and clinical translation in this field.

PMID:41585901 | PMC:PMC12823788 | DOI:10.3389/fphar.2025.1715189

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Hyperhidrosis: Prevalence, Diagnosis, and Stepwise Treatment

Dtsch Arztebl Int. 2026 May 1;(Forthcoming):arztebl.m2025.0229. doi: 10.3238/arztebl.m2025.0229. Online ahead of print.

ABSTRACT

BACKGROUND: Hyperhidrosis, or sweating beyond the physiological amount, can be either focal or generalized and sometimes runs in families. The prevalence of primary idiopathic hyperhidrosis is 2-5%. Secondary hyperhidrosis is associated with specific illnesses and medications. In this article, we discuss the diagnostic evaluation of hyperhidrosis and treatments for it, along with their efficacy and side effects.

METHODS: This narrative review is based on publications retrieved from the Medline and Cochrane databases with the search term “hyperhidrosis” and other specific terms relating to treatment. Expert recommendations and guidelines were considered as well.

RESULTS: The diagnostic evaluation consists of a clinical history, a Minor (starch-iodine) test, gravimetry, and dynamic sudometry. There have been no more than a few high-quality published studies on specific interventions. Depending on the severity and symptom burden, aluminum chloride and anticholinergic drugs are used first, followed by botulinum toxin injections and subcutaneous curettage for axillary hyperhidrosis. These treatments reportedly bring about marked improvement in 60-70 % of patients; their side effects, depending on the particular treatment used, include local reactions such as itch, pain, and cutaneous irritation and anticholinergic effects such as dry mouth, mydriasis, urinary retention, and headache. Further therapeutic options are tap water iontophoresis; radiofrequency, focused ultrasound, and microwave treatment; systemically administered anticholinergic drugs; and thoracic or lumbar sympathectomy for palmar or plantar hyperhidrosis, respectively.

CONCLUSION: A variety of methods can be used to relieve hyperhidrosis and improve these patients’ quality of life. There have been no more than a few high-quality studies on their efficacy and long-term results.

PMID:41572865 | DOI:10.3238/arztebl.m2025.0229

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A predictive model for postoperative compensatory hyperhidrosis in primary palmar hyperhidrosis: a retrospective cohort study

J Thorac Dis. 2025 Dec 31;17(12):11253-11261. doi: 10.21037/jtd-2025-1562. Epub 2025 Dec 26.

ABSTRACT

BACKGROUND: While sympathectomy remains the optimal surgical intervention for severe primary palmar hyperhidrosis (PPH), compensatory hyperhidrosis (CH) has emerged as the most significant factor contributing to postoperative patient regret. This retrospective study aimed to identify risk factors and develop a predictive model for moderate-to-severe compensatory hyperhidrosis (msCH) in patients with PPH.

METHODS: A total of 1,013 patients were retrieved from the institutional database between 2014 and 2024. Logistic regression modeling was utilized to identify risk factors for msCH. A nomogram for predicting msCH was developed accordingly.

RESULTS: Of the initial cohort, there were 903 patients included in the final analysis, among whom 182 (20.2%) developed msCH. The following factors were identified as independent risk factors for msCH: age >25 years [odds ratio (OR) 3.32, 95% confidence interval (CI): 2.23-4.95, P<0.01], smoking history (OR 6.46, 95% CI: 4.37-9.54, P<0.01), higher body mass index (BMI) (OR 1.68, 95% CI: 1.10-2.56, P=0.02), palmar-axillary hyperhidrosis (OR 2.37, 95% CI: 1.57-3.57, P<0.01), and T3 sympathectomy (OR 3.14, 95% CI: 2.03-4.85, P<0.01). A predictive nomogram for msCH was developed based on these factors. Receiver operating characteristic (ROC) curve analysis demonstrated an area under the curve (AUC) of 0.839, indicating good predictive performance.

CONCLUSIONS: Age >25 years, smoking history, higher BMI, palmar-axillary hyperhidrosis, and T3 sympathectomy were independent risk factors for msCH. Based on these factors, a predictive model for msCH was developed and showed high predictive accuracy.

PMID:41522169 | PMC:PMC12780405 | DOI:10.21037/jtd-2025-1562

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Thoracoscopic Sympathectomy for Primary Hyperhidrosis: A 3 mm Two-Port Approach

J Laparoendosc Adv Surg Tech A. 2025 Dec 12. doi: 10.1177/10926429251405812. Online ahead of print.

ABSTRACT

Background: Primary hyperhidrosis is a debilitating condition characterized by excessive focal sweating, most commonly affecting the axillae, palms, and soles, for which surgical intervention provides a durable solution in patients refractory to medical management. Methods: We present our outpatient surgical technique for video-assisted thoracoscopic sympathectomy (VATS) using a two-port, 3-mm incision approach and evaluate its efficacy and outcomes. A case series of 33 consecutive patients undergoing outpatient VATS sympathectomy between 2016 and 2023 was reviewed, with 9 patients excluded for lack of postoperative follow-up. All procedures were performed with electrocautery at the third and fourth ribs posteriorly (T3 and T4). Results: The technique demonstrated consistent efficacy in symptom resolution with short operative times, low postoperative pain, and rapid recovery. Mean operative time was 22.0 ± 3.7 minutes, with same-day discharge achieved in all patients. The average pain score at discharge was 2.0 ± 2.6, and no intraoperative or immediate postoperative complications occurred. Symptom severity scores improved across all regions, most notably in the palms (8.8 ± 2.1 to 1.3 ± 2.1, P < .001) and axillae (7.1 ± 2.9 to 2.2 ± 2.3, P < .001), with improvement also observed in plantar sweating (8.6 ± 2.0 to 4.8 ± 3.0, P < .001), while facial sweating showed a modest, nonsignificant change (2.3 ± 2.8 to 1.5 ± 2.2, P = .21). At 2-4 weeks, complication rates, including compensatory hyperhidrosis and pneumothorax, were comparable to conventional methods. Conclusion: This minimally invasive two-port VATS sympathectomy with 3-mm incisions appears safe, effective, and patient-centered, supporting its use as a surgical approach for primary hyperhidrosis.

PMID:41467293 | DOI:10.1177/10926429251405812

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Compensatory hyperhidrosis following endoscopic thoracic sympathectomy: a 5-year follow-up study of risk factors and symptom progression

J Cardiothorac Surg. 2025 Dec 8. doi: 10.1186/s13019-025-03720-3. Online ahead of print.

ABSTRACT

BACKGROUND: Compensatory hyperhidrosis (CH) is a common complication after endoscopic thoracic sympathectomy (ETS) for hyperhidrosis. Despite its prevalence, long-term data on CH progression and associated risk factors are scarce. This study aimed to evaluate the risk factors and progression of CH during a 5-year follow-up period.

METHODS: This study retrospectively analyzed 138 patients with primary palmar hyperhidrosis (PPH) who underwent endoscopic thoracic sympathectomy between January 2014 and December 2019. All patients received bilateral single-port thoracoscopic sympathectomy and were followed up at 1, 3, and 5 years postoperatively. The severity of postoperative sweating was assessed using the Hyperhidrosis Disease Severity Scale (HDSS). Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with the development and progression of CH.

RESULTS: A total of 138 patients were included in the study, with 78.9% reporting the occurrence of CH after surgery and 23.8% of them experiencing severe CH. HDSS scores gradually increased over the 5-year postoperative period, indicating symptom worsening. Further analysis revealed that bilateral R4-level sympathectomy significantly increased the risk of CH progression (OR = 4.28, 95% CI: 1.27-15.60, P = 0.021) while having three or more affected areas was identified as a protective factor (OR = 0.19, 95% CI: 0.05-0.63, P = 0.008).

CONCLUSION: This study found that compensatory hyperhidrosis is relatively common in patients undergoing ETS, and symptoms may progressively worsen over time. The level of sympathetic nerve resection and the number of affected areas are key predictive factors for symptom progression.

PMID:41361439 | DOI:10.1186/s13019-025-03720-3

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Scar-concealed 2 + 3 mm dual-port thoracoscopic sympathectomy for palmar hyperhidrosis: single-center outcomes

Front Surg. 2025 Oct 24;12:1664901. doi: 10.3389/fsurg.2025.1664901. eCollection 2025.

ABSTRACT

OBJECTIVE: To minimize the trauma and incision of the operation for primary palmar hyperhidrosis (PPH), we have designed a inconspicuous scar thoracoscopic bilateral thoracic sympathetic chain transection via “2 + 3 mm” two-pinhole incisions (ISTTST). This study mainly retrospectively compares and analyzes the pros and cons of this surgical method vs. the conventional single-port thoracoscopic sympathetic nerve transection (CSTTST).

METHODS: Data of patients with moderate or severe PPH and underwent thoracic sympathetic chain transection were collected. Patients undergoing ISTTST and those receiving CSTTST were included in the two-pinhole group and the single-port group respectively. The baseline characteristics, intraoperative and postoperative conditions of the two groups were compared.

RESULTS: A total of 265 patients were enrolled, including 162 in the single-port group and 103 in the two-pinhole group. There were no statistically significant differences in baseline conditions such as gender, age, BMI, age of onset of PPH, hyperhidrosis sites, hyperhidrosis degree, and transection level of thoracic sympathetic chain between the two groups (P > 0.05). The two-pinhole group had shorter operation time (19.809 ± 3.356 min vs. 22.534 ± 4.541 min), lower postoperative incision pain score (1.563 ± 0.518 vs. 2.012 ± 0.788), and better incision satisfaction (9.437 ± 0.498 vs. 8.068 ± 1.424) (all P < 0.001). There were no statistically significant differences in postoperative conditions such as surgical effect, 24-h postoperative discharge rate, postoperative complication rate, postoperative compensatory hyperhidrosis, postoperative recurrence rate of PPH, and postoperative follow-up time between the two groups (P > 0.05).

CONCLUSION: The ISTTST is a more concealed-scar, minimally invasive, and convenient procedure, meeting the aesthetic needs. Compared with the CSTTST, it has certain advantages and deserves more attention and attempts.

PMID:41209064 | PMC:PMC12592174 | DOI:10.3389/fsurg.2025.1664901

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Pleural effusion following thoracoscopic sympathectomy in a patient with palmar hyperhidrosis

BMC Pulm Med. 2025 Oct 2;25(1):446. doi: 10.1186/s12890-025-03933-1.

ABSTRACT

Thoracoscopic sympathectomy can be used to treat primary hyperhidrosis (PH). Nonetheless, there is a paucity of literature addressing the postoperative complications associated with this procedure. We report a case of a 21-year-old male patient who developed prolonged bilateral pleural effusion after undergoing thoracoscopic sympathectomy for PH. This case aims to raise awareness of this rare complication and discuss effective management strategies for it.

PMID:41039538 | DOI:10.1186/s12890-025-03933-1

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Unilateral versus Bilateral T3 Ganglionectomy in Primary Palmar Hyperhidrosis Patients

Thorac Cardiovasc Surg. 2025 Sep 11. doi: 10.1055/a-2699-8163. Online ahead of print.

ABSTRACT

BACKGROUND: Primary palmar hyperhidrosis (PPH) is a distressing condition that significantly impairs quality of life. Endoscopic thoracic sympathectomy (ETS) is an effective treatment, but compensatory hyperhidrosis (CH) remains a common and problematic complication. The optimal extent of surgical interruption, particularly the choice between unilateral and bilateral ganglionectomy, remains uncertain.

METHODS: We conducted a retrospective analysis of 118 patients who underwent unilateral (n=41) or bilateral (n=77) T3 ganglionectomy via video-assisted thoracoscopic surgery (VATS) between November 2023 and January 2025. Patient-reported outcomes, including CH and postoperative satisfaction, were assessed three months postoperatively using standardized questionnaires. Comparisons between the two groups were performed using t-tests and chi-square tests.

RESULTS: Baseline demographics were comparable between groups. The unilateral group reported significantly higher satisfaction, with 93% “very satisfied” compared to 61% in the bilateral group (p<0.001). CH was less prevalent in the unilateral group (20% vs. 48%, p=0.007), and when present, was generally mild and limited to a single body region. In contrast, bilateral ganglionectomy was associated with more frequent and multi-regional CH. Among unilateral ETS patients, only 22% later underwent contralateral surgery, indicating that unilateral intervention was sufficient in most cases.

CONCLUSIONS: Unilateral T3 ganglionectomy offers a favorable balance of efficacy and safety, yielding higher satisfaction and significantly reduced CH compared to bilateral procedures. These findings support the use of unilateral ETS as a first-line surgical strategy for PPH, particularly in patients sensitive to CH. A tailored, staged approach may enhance long-term outcomes and patient satisfaction.

PMID:40935159 | DOI:10.1055/a-2699-8163