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Christoph Neumayer, MD; Peter Panhofer, MD; Johannes Zacherl, MD; Georg Bischof, MD

Arch Surg. 2005;140:676-680.

Hypothesis  Endoscopic thoracic sympathetic block at T4 (ESB4) provides excellent results in patients with primary hyperhidrosis (HH) of the upper limb. Most patients have combined palmo-plantar or palmo-axillary-plantar HH. This study evaluates the clinical outcome of patients with upper limb HH with special emphasis on plantar sweating and patients’ quality of life.

Design  Review of a prospectively gathered database.

Setting  Tertiary care university teaching hospital.

Patients  The cohort included 73 patients (50 women and 23 men; mean age, 30.2 years). Twenty-six patients had palmar; 3, isolated axillary; and 44, combined HH. Sixty-six patients (90.4%) had concomitant plantar HH.

Interventions  One hundred forty-five operations were performed by applying one 5-mm clip above and below the fourth sympathetic ganglion.

Results  Of palms, 71.9% were completely and 28.1% were nearly dry. Corresponding percentages were 45.1% and 50.5% for armpits and 4.5% and 37.9% for the soles, respectively. Of soles, 42.4% remained unchanged and 15.2% became slightly worse. Compensatory sweating occurred in 19.4% of patients, with 2.8% having severe compensatory sweating. Feet were rarely affected by compensatory sweating (5.6%). Gustatory sweating was reported by 31.9% of patients but did not bother them. Quality of life improved significantly after ESB4. Most patients (87.5%) were completely satisfied with the outcome; 9.7% were partly satisfied.

Conclusions  In the treatment of upper limb HH, ESB4 yields excellent success rates. Plantar sweating can be relieved in nearly half of patients, although exact neurophysiologic mechanisms remain unclear. Incidence of compensatory and gustatory sweating is low, contributing to a high patient satisfaction and improvement in quality of life.

Author Affiliations: Department of General Surgery, University Clinic of Surgery (Drs Neumayer, Zacherl, and Bischof), Institute of Anatomy, Department III (Dr Panhofer), Medical University of Vienna, Austria.

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