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Compensatory Sweating - New Details and New Information - News from and Dr. Karamanoukian

By: Hratch Karamannoukian MD and Raffy Karamanoukian MD

August 11, 2008

Endoscopic Thoracic Sympathectomy (ETS) in Children and Adults – New Information About Compensatory Sweating

Compensatory sweating (CS) is a major side effect of ETS. Researchers at the Department of Pediatric Surgery, Hillel Yaffe Medical Center, Hadera, Israel  surveyed thoracic sympathectomy (ETS) patients to determine the procedure's long-term success, satisfaction, complications, the natural history of compensatory sweating – and whether those with compensatory sweating would still have undergone the procedure. 621 patients (mean age, 16.1 years) with a follow-up of more than 24 months were included in this study, published in the Journal of Pediatric Surgery (volume 42, page 1238-1242). Most participants (97%) reported complete (89.4%) or reasonable (7.6%) symptomatic relief and long-term satisfaction with ETS was high (84.5%). Of note, 41% of the participants claimed that their quality of life decreased moderately or severely as a result of compensatory sweating. About one in 5 patients stated that they would not have undergone the operation in retrospect – with a significant interesting difference regarding this issue between adults (31.4%) and children (8.8%).

Some very interesting NEW findings regarding compensatory sweating from this study is that the extent of compensatory sweating did not change with time in 70% of the patients. It got worse in 10% and it diminished in 20%, usually within the first 2 postoperative years.

The researchers concluded that thoracoscopic sympathectomy relieves hyperhidrosis in most cases. Hyperhidrosis is not a self-limiting condition, and we recommend not postponing ETS until adulthood.

Dr. karamanoukian's comment - This is certainly new information about compensatory hyperhidrosis. Patients always want to know the following: " Will I get compensatory sweating? Can you predict who will get compensatory sweating? How much compensatory sweating will I have? Where will I get compensatory sweating? Will it be continuous or intermittent? Will compensatory sweating get better over time? Can compensatory sweating get worse? How soon after surgery can I expect to have compensatory sweating?

I have always maintained that compensatory sweating is more common when ETS is performed for head and neck sweating than for palmar and/or underarm sweating. I also tell patients that it cannot be predicted who will get it, how much it will be, where it will be, if it will get better over time or worsen, and if it will be reversible with clip removal.

This study from Israel certainly addresses some of these questions (not all) and relates it to ETS outcomes in children versus adults. It also answers some questions about the fact that it can get worse over time in 20% and improve in 10% as well as the fact that it remains unchanged in 70% of patients. What does this mean to our individual practices? I always tell patients that if you don't want to risk having compensatory sweating then don't have the ETS procedure. I also give them time to read as much as possible on the internet and to return for more questions.

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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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