Sympathicotomy is currently the most effective treatment for palmar hyperhidrosis; however, there is a lack of consensus regarding treatment of patients with palmar hyperhidrosis accompanied by axillary and/or plantar sweating.
We retrospectively analysed the data of patients with palmar hyperhidrosis accompanied by axillary and/or plantar sweating who underwent bilateral thoracoscopic sympathicotomy and explored the optimal level of sympathicotomy.
There was no significant difference in baseline characteristics and early postoperative results between the two groups. In the follow-up period, the improvement of the degree of palmar sweating in the T3+T4 group was better (p < 0.05). The incidence of compensatory hyperhidrosis was significantly rarer in group T4 (p < 0.05). For patients with palmar hyperhidrosis accompanied by axillary sweating, the improvement rate of axillary sweating was higher in group T3+T4, both at 1 month and 3 years after surgery (p < 0.05). For patients with palmar hyperhidrosis accompanied by plantar sweating, the improvement rate was 33.3% in group T4 and 70% in group T3+T4 at 3 years after surgery (p < 0.05). Satisfaction rate and recurrence rate showed no statistical significance between the two groups (all p > 0.05). Group T3+T4 had a lower the Hyperhidrosis Quality of Life Index score (p < 0.05).
Both T3+T4 sympathicotomy and T4 sympathicotomy were safe and effective, but T4 sympathicotomy led to a lower incidence of compensatory hyperhidrosis. T3+T4 sympathicotomy may be more suitable for patients with palmar hyperhidrosis accompanied by axillary and/or plantar sweating.
