Comparison between different levels of sympathectomy on outcomes of Palmar hyperhidrosis

Abstract

Background: Thoracoscopic sympathectomy (VATS) is definitive for severe palmar hyperhidrosis, but compensatory sweating (CS) remains a major drawback. We analyzed predictors of CS and patient regret in a 5-year cohort. Methods: Observational study of 268 consecutive patients (mean age 17.5±4.8 years; 54.4% female) undergoing VATS (2019–2024). Sympathectomy levels included T3-T4 (80.8%), T3-T5 (12.1%), or single-level (8.3%). Outcomes assessed CS incidence, regret rates, and multivariate predictors. Results: CS occurred in 32.5% (86/268), with severe cases in 1.5% (9/268). Age independently predicted CS (aOR 1.126/year, *p*<0.001), and patients >24 years had 36.8% higher regret odds (OR 1.368, *p*<0.001). Winter surgeries reduced CS risk by 68.3% (aOR 0.317, *p*=0.03), while surgeon variability impacted outcomes (3.08-fold CS risk difference, *p*=0.001). Extent of sympathectomy showed no significant CS association (*p*=0.117). Satisfaction was high (96%), with 3.4% regret, lower than literature averages. Conclusion: Younger age and winter procedures correlate with lower CS risk, while surgeon experience influences outcomes. Despite CS, VATS achieves exceptional satisfaction, supporting its role in debilitating hyperhidrosis.