Surgical treatment of primary palmar hyperhidrosis: a prospective randomized study comparing T3 and T4 sympathicotomy

OBJECTIVE: Endoscopic thoracic sympathetic surgery was effective for palmar hyperhidrosis (PH), but side effects such as compensatory sweating and over dry hands were common. A multiple centers prospective randomized study was designed to compare the efficiency and side effects of T3 and T4 sympathicotomy in the treatment of PH. METHODS: From September 2004 to February 2006, 141 consecutive patients with PH were randomized into two therapeutic groups: group T3 underwent T3 sympathicotomy (n=68) and group T4 underwent T4 sympathicotomy (n=73). Improvement of hand sweating, side effects like compensatory sweating or over dry hands, and satisfactory rate of the patients were recorded. RESULTS: There were 78 males and 63 females. The median age was 26.9 years. The two groups were comparable in gender, age, severity of sweating and average period of follow-up. All operations were successful with no severe complications or perioperative mortality. A 17.8+/-7.9 month follow-up showed that palmar sweating improved in all patients and the effective rate was 100%. Mild moist hands occurred more frequent in group T4 than in group T3 (59.4% vs 25.8%, p<0.0001). Most involved patients were 'very satisfied' with this result except for four patients (5.8%) in group T4; incidences of compensatory sweating and over dry hands were both lower in group T4 than in group T3 (56.5% vs 77.4%, p=0.011 and 1.4% vs 12.9%, p=0.013, respectively). Moderate compensatory sweating (CS) occurred in 14.5% in group T3 and 2.9% in group T4 (p=0.017). 'Very satisfied' rate was higher in group T4 than in group T3 (p<0.0001) while 'partially satisfied' rate was comparable between the two groups. CONCLUSION: T3 and T4 sympathicotomies are both effective for the treatment of PH. T4 sympathicotomy, decreases the side effects but do not compromise the therapeutic effects, and should be the method of choice.