Endoscopic thoracic sympathectomy: long-term results for treatment of upper limb hyperhidrosis and facial blushing

Acta Chir Belg. 2011 Sep-Oct;111(5):293-7.


Background: Endoscopic thoracic sympthectomy (ETS) is frequently used in the management of patients with hyperhidrosis and excessive blushing. Long term-follow up is scarce. We retrospectively reviewed long-term morbidity, success and overall patient satisfaction rates in patients operated in our department.

Method: Data of all patients undergoing ETS for either upper limb hyperhidrosis or facial blushing and sweating between January 1994 and December 2006 were reviewed. A standard questionnaire inquiring on relief of symptoms, satisfaction with the operation and occurrence of compensatory sweating (CS) was sent out in January 2008.

Results: We performed bilateral thoracoscopic sympathectomies in 73 patients. There were no operative mortalities, minor complications occurred in 22%. Initial success rate was 88%. Median follow up was 93 (24-168) months, response rate to the questionnaire was 85%. Sixty-nine per cent of patients continued to have relief of initial symptoms, whereas patient satisfaction rate was 56%. CS was present in 42 patients (68%). Long-term satisfaction rates per initial indication group were 42% for facial blushing and 65% for hyperhidrosis (n.s.), and CS was present in 79% vs 61%, respectively.

Conclusion: ETS appears a safe treatment for upper limb hyperhydrosis with acceptable long-term results. For excessive blushing, however, long-term satifaction rates of ETS are severely hampered by a high incidence of disturbing compensatory sweating. ETS should only be indicated in patients with unbearable symptoms refractory to non-surgical treatment. The patient information must include the long-term substantial risk for sever CS and regret of the procedure.

MeSH terms

  • Adolescent
  • Adult
  • Endoscopy / methods*
  • Female
  • Flushing / surgery*
  • Humans
  • Hyperhidrosis / surgery*
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Sympathectomy / methods*
  • Thoracic Nerves / surgery*
  • Treatment Outcome
  • Upper Extremity
  • Young Adult