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Invited Critique
July 1, 2005

Effect of Endoscopic Thoracic Sympathetic Block on Plantar Hyperhidrosis—Invited Critique

Arch Surg. 2005;140(7):680. doi:10.1001/archsurg.140.7.680

This article reviews patients with hyperhidrosis treated with hemoclips on the sympathetic chain above and below the fourth ganglion. Results, in percentage of anatomical areas rendered completely or “nearly” dry, for palms are 71.9% and 28.1%, respectively; for axillae, 45.1% and 50.5%; and for the soles, 4.5% and 37.9%. They reported compensatory sweating in 19.4% of patients, severe in only 2.8%. These procedures were done with minimal morbidity.

These results are good but do not identify the ideal operation. Alternatives range from electrocautery of the sympathetic chain and division only of the rami communicantes, to sympathectomy. In addition, there is a range of reported success and of the complication of compensatory sweating. For example, with sympathectomy, success rates of relief of palmar hyperhidrosis of 100% have been reported but with an incidence of compensatory sweating up to 88%, although only severe in 2% of patients.

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