Surgical Management of Hyperhidrosis

Hyperhidrosis is a pathologic condition in which excessive sweating occurs beyond the person’s physiological needs to maintain thermal homeostasis. Patients with primary palmar hyperhidrosis are the most suitable for surgery as first-line treatment due to the high rate of satisfaction reported. Endoscopic thoracic sympathectomy is the procedure of choice for treatment of primary hyperhidrosis as it allows for excellent visualization and precise identification of the sympathetic chain. For palmar hyperhidrosis, a R3 and R4 interruption either by cauterizing, cutting, or clipping the sympathetic chain yields the most favorable results. Most distressing complication following surgical treatment is compensatory hyperhidrosis, which can be reduced by avoiding trunk interruption around G2 and limiting the number of interruption levels.