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Correspondence and Brief Communications
January 1, 2005

Video-Assisted Thoracic Surgery Sympathectomy for Hyperhidrosis

Arch Surg. 2005;140(1):99. doi:10.1001/archsurg.140.1.99-a

In his report on sympathectomy for hyperhidrosis, Little1 concludes in the “Abstract,” based on 31 patients, “palmar hyperhidrosis is predominantly a disease of young Asian women.” He notes that, “Significant surgical experiences . . . have been reported, but almost completely by groups from outside of North America.”

I have performed endoscopic thoracic sympathectomy for hyperhidrosis on an outpatient basis on more than 2200 patients in the United States, currently using single-lumen intubation, 2 trochars, and no chest tubes. My colleagues and I2,3 have published reports on more than 1300 patients using both the cauterization and clamping methods, and I have recently submitted a paper on 1274 patients in whom the clamping method was used. A detailed demographic analysis, including evaluation of characteristics and outcomes by sex and ethnicity, was performed in an article I published along with colleagues.3 Of 1312 patients in that study, 55.9% were male and 68.1% were white. Only 17.3% were Asian, with 12.8% Hispanic and 1.6% black. The mean age was 30 years, but 14.6% were older than 40, with the oldest being age 66. Demographic characteristics of my recent series are similar. Therefore, I cannot agree with Little’s conclusion that hyperhidrosis occurs primarily in young Asian women. In fact, 66.5% of Asians in my series were male, a significantly greater proportion than in the other ethnicities. Differences in characteristics and outcome by sex and ethnicity occurred, but no differences in satisfaction rate. Overall, palmar hyperhidrosis was cured in all but 1 patient, with a 96% satisfaction rate (98% with clamping). Severe compensatory hidrosis occurred in less than 6%, recurrence in less than 3%, and surgical complications were rare.