Immediate and short-term results of endoscopic thoracic sympathectomy (ETS) for primary hyperhidrosis are good. Adverse effects have been identified clearly and are supposed to decrease with time. In this institutional report, the long-term results of ETS with regard to efficacy, side effects and patient satisfaction are presented. Fifteen patients were included and mean follow-up time was 12+/-2 years. ETS success rate, rate of compensatory sweating and degree of patient satisfaction were assessed. We detected 8 patients (53%) complaining about a decent to moderate recurrence of hand sweating and compensatory and gustatory sweating were observed in 9 (60%) and 5 (33%) patients, respectively. Reported side effects related to surgery were paresthesias of the upper limb and the thoracic wall in 8 patients (53%) and recurrent pain in the axillary region in one. At an average 12 years after surgery, 47% of patients were satisfied with the treatment results, 40% were disappointed. Six patients (40%) affirmed they would ask for the operation if it were to be redone. Our findings indicate that results of ETS deteriorate and compensatory sweating does not improve with time. It is mandatory to inform patients of the potential long-term adverse effects before surgery.