Thoracoscopic sympathectomy for palmar hyperhidrosis - Ablate or resect?

Background: Upper thoracoscopic sympathectomy, obtained either by ablation or resection of the appropriate ganglia, is now the preferred treatment for primary palmar hyperhidrosis. Therefore, we undertook a review to compare the relative efficacy of these two techniques. Methods: A Medline search was performed for the years 1974-99 to identify all published studies of thoracoscopic sympathectomy for hyperhidrosis. Results: In all, 33 studies were identified and divided into two groups-ablation and resection. When the resection method was used, the immediate success rate was 99.76%, whereas the ablation method achieved dry hands in 95.2% of cases (p = 0.00001). Palmar sweating recurred in 0% of patients treated via resection and 0-4.4% treated with ablation. Ptosis was noted in 0.92% of cases after ablation and in 1.72% after resection (p = 0.017). Conclusions: Resection yields superior results, yet the majority of surgeons ablate, probably because it is easier, re-quires a shorter operating time, leads to fewer cases of Homer's syndrome, and because resympathectomy eventually overcomes initial failure.