Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limb

A non-randomised comparative study of 154 patients with palmar hyperhidrosis treated by endoscopic thoracic sympathectomy (ETS) or botulinum-toxin A injection reported statistically significant improvements in both groups at 6‑ and 12‑month follow-up, assessed objectively using an iodine starch test and pad glove test (p<0.05). The improvement was significantly higher in the ETS group than the botulinum-toxin A injection group (94% and 30% change on the iodine starch test respectively, p=0.01).

A case series of 1,700 patients (1,052 [62%] patients with hyperhidrosis, 536 [32%] patients with facial blushing and 112 [7%] patients with combinations of blushing and hyperhidrosis) reported that 85% of patients had a 'satisfactory and lasting effect' from the procedure at a mean follow-up of 15 years (absolute number not reported). A case series of 406 patients with palmar and/or axillary hyperhidrosis reported that 91% (n=239) of patients treated by conventional ETS had dry limbs at a mean follow-up of 17 years.

The non-randomised comparative study of 154 patients reported a statistically significant higher mean satisfaction score for ETS compared with botulinum-toxin A injection at 12‑month follow-up (4.52 and 3.12, respectively [score range 1 to 5 with 1 being very poor and 5 being excellent], p=0.001). The case series of 1,700 patients reported satisfaction rates of 87% and 67% for palmar and axillary hyperhidrosis respectively (p<0.001). Overall, 75% of patients stated that the procedure had improved their quality of life (absolute numbers not reported).

A case series of 2,000 patients reported recurrence rates of 0% and 4% for palmar and axillary hyperhidrosis respectively at 1‑year follow-up and 1% and 17% respectively at 5‑year follow-up. A case series of 9,988 patients with palmar hyperhidrosis reported that 'almost all' patients obtained satisfactory relief immediately after ETS; recurrence rates were about 1% at 1‑year follow-up and less than 3% at 3‑year follow-up (absolute numbers not reported).

The case series of 453 patients with palmar, axillary or facial hyperhidrosis reported that 91% (412 out of 453) had better quality of life 30 days after ETS and 90% (409 out of 453) had better quality of life 5 years after ETS. All patients had poor or very poor quality of life before treatment.

The specialist advisers stated that key efficacy outcomes were reduction in hyperhidrosis and patient satisfaction.