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Compensatory Sweating Following Endoscopic Thoracic Sympathectomy (ETS)

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 28, 2008

Compensatory Sweating Following Endoscopic Thoracic Sympathectomy (ETS)

Dr. Baumgartner and colleagues investigated the safety, efficacy, and side effects of the various medical treatments versus bilateral thoracoscopic sympathectomy (BTS) for palmoplantar hyperhidrosis in 192 consecutive patients in a prospective manner and reported their findings in the Annals of Vascular Surgery (July 9, 2008).

Of the 47 patients, 46 received topical aluminum chloride, 40 anticholinergics, six iontophoresis, and 45 endoscopic thoracic Sympathectomy. Interestingly, only one patient was successfully treated with aluminum chloride (2.2%) and one successfully treated with anticholinergics (2.5%), and these did not undergo surgery.

All medical treatments failed with the exception that one patient was satisfied with anticholinergic treatment (2.6%), and this patient did not undergo Sympathectomy.

As such, Sympathectomy was found to be “superior in treating palmar hyperhidrosis compared to aluminum chloride, anticholinergics, iontophoresis, and Botox”.

Overall, compensatory hyperhidrosis (CH) was present in 56% of patients undergoing thoracic Sympathectomy.

Only 3.2% of thoracic Sympathectomy patients had severe compensatory sweating with significant discomfort.

Dr. Baumgartner concluded that the “safety and overwhelming efficacy of thoracic Sympathectomy compared to medical management of severe palmoplantar hyperhidrosis is demonstrated in this study”. Furthermore, he concluded that “Rather than being a "last resort," Endoscopic thoracic Sympathectomy can be confidently recommended as first-line treatment for the typical, severe form of palmoplantar hyperhidrosis”.

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For more information about hyperhidrosis (excessive sweating) , as well as surgical and non-surgical hyperhidrosis treatment options, contact Dr. Karamanoukian at The Center for Excessive Sweating, a National Center of Excellence for Hyperhidrosis Treatment by email or by phone at (716) 839-3638.

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