Outcome of Bilateral Thoracoscopic Sympathectomy for Patients with Primary Focal Hyperhidrosis, Sohag University Hospital Experience

Essam Elbadry Hashim  Mohamed; Mohamed Ashraf Mokhtar; Mohsen Saber Mohammed Ahmed

Essam Elbadry Hashim Mohamed Department of Cardiothoracic Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt
Mohamed Ashraf Mokhtar Department of Cardiothoracic Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt
Mohsen Saber Mohammed Ahmed Department of Cardiothoracic Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt

Keywords: Primary focal hyperhidrosis, bilateral thoracoscopic sympathectomy, Compensatory sweating, Hyperhidrosis Disease Severity Scale

Abstract

Background: Primary focal hyperhidrosis (PFH) causes excessive sweating and significant quality-of-life impairment, with symptoms aggravated by emotional stress and anxiety. Conservative treatments often provide only temporary relief, making endoscopic thoracic sympathectomy (ETS) the definitive option, though traditional T2 interruption carries a high risk of compensatory sweating. Lower T3–T4 interruption may reduce this complication, but regional data are lacking. This study assesses the efficacy and safety of T3–T4 bilateral thoracoscopic sympathectomy in Egyptian patients.

Methods: This prospective study included 20 patients (≥16 years) with severe PFH (HDSS ≥3) unresponsive to conservative therapy, excluding those with severe cardiopulmonary disease or bleeding disorders. Diagnosis was confirmed clinically and with Minor starch–iodine testing. All patients underwent bilateral thoracoscopic T3–T4 sympathicotomy. Outcomes included symptom resolution, compensatory sweating, QoL (DLQI), complications, and recurrence, with follow-up up to 6 months.

Results: Twenty patients (mean age 20.9 years; 65% male) with severe PFH underwent bilateral thoracoscopic T3–T4 sympathectomy. All procedures were completed safely with minimal blood loss and rapid recovery. HDSS scores dropped from a median of 4 to 0 (p < 0.001), with high patient satisfaction (median 10/10). Compensatory sweating occurred in 15% (mild/moderate), and one patient (5%) had recurrence. Functional and occupational outcomes improved in nearly all patients, sustained at a mean follow-up of 8.6 months.

Conclusion: T3–T4 bilateral thoracoscopic sympathectomy is a safe, effective surgical option for severe PFH. It produces excellent symptom control, minimal morbidity, high patient satisfaction, and acceptable levels of compensatory sweating. With continued refinement of technique and patient selection, T3–T4 BTS can be considered a reproducible standard of care in resource-constrained settings.