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Eur J Cardiothorac Surg 2005;27:741-744
© 2005 Elsevier Science NL

Video assisted thoracoscopic re-sympathetic surgery in the treatment of re-sweating hyperhidrosis

^a Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital, Daejeon, South Korea
^b Department of Thoracic and Cardiovascular Surgery, Respiratory Center, Yongdong Severance Hospital, Yonsei University College of Medicine, 146-92, Dogok-dong, Kangnam-gu, Seoul 135-720, South Korea

Received 12 December 2004; received in revised form 26 January 2005; accepted 31 January 2005.

^* Corresponding author. Tel.: +82 2 3497 3380; fax: +82 2 3461 8282. (E-mail: hcpaik{at}yumc.yonsei.ac.kr).

Objective: The characteristics and causes of re-sweating after sympathetic surgery in hyperhidrosis patients have yet to be clearly documented due primarily to low incidence of re-sympathetic surgery. The purpose of this study is to identify the causes of re-sweating following sympathetic surgery, and to assess the outcomes of re-sympathetic surgery. Methods: From February 1997 to July 2003, 36 patients underwent re-sympathetic surgery in order to treat re-sweating. Patients originally underwent sympathetic surgery due to facial (14 cases), palmar (21 cases), and axillary (1 case) hyperhidrosis. Results: Sympathectomy was performed as a primary surgical intervention in 7 cases (19.4%), sympathicotomy in 12 cases (33.3%), and sympathetic clipping in 17 cases (47.3%). Thirteen patients complained of re-sweating on both sides, and 23 patients exhibited unilateral re-sweating. The onset of re-sweating occurred after an average of 3.1±3.4 months (range, 1–12 months) after the operation. The causes of re-sweating after sympathetic surgery included an intact sympathetic chain in 4 cases (11.1%), incomplete resection in 6 cases (16.7%), partial reattachment in 6 cases (16.7%), improper ganglion location in 4 cases (11.1%), clip slipping out in 11 cases (30.5%), and unknown in 5 cases (13.9%). Twenty-seven patients (75.0%) exhibited re-sweating within 3 months, and 9 patients (25.0%) experienced re-sweating after 6 months. During the second operation, sympathicotomy was performed in 20 cases (55.6%) and sympathetic clipping in 16 cases (44.4%) in which 32 patients (88.9%) reported decreased sweating. Conclusions: Surgical errors during the initial operation constituted the main cause of re-sweating following sympathetic surgery. Re-sympathetic surgery was necessary in order to treat re-sweating, and was associated with favorable outcomes.

Key Words: Hyperhidrosis • Sympathectomy • Re-sympathectomy • Re-sweating

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