Thoracoscopic T3-T4 versus T4 sympathectomy for primary axillary hyperhidrosis: A comparative study

Background: Primary axillary hyperhidrosis could be managed with various video-assisted thoracoscopic sympathectomy procedures.We compared two levels of ganglion excision for managing primary axillary hyperhidrosis: T3-T4 and T4.Methods: A prospective study was conducted from March 2019 to January 2023.It enrolled seventy patients with axillary hyperhidrosis and randomly assigned them to two groups.Thirty-five patients were surgically treated with thermal ablation of T3-T4, while 35 patients were surgically treated with thermal ablation of T4 only.Both groups were followed up at one, six, and twelve months after surgery.The presence and severity of associated compensatory sweating (CS) were evaluated.Patient satisfaction was assessed using a questionnaire.Results: The mean age was 26.7±8.1 years in the T3-T4 group and 25.9±7.3years in the T4 group.There were 19 (54.2%) males in T3-T4 group and 17 males (48.5%) in T4 group.Family history was positive in 25 patients (71.4%) in T3-T4 group and 23 patients (65.7%) in T4 group.No mortality, postoperative complications,or thoracotomy conversions were observed in both groups.The rate of immediate operative success was 100% in both groups.The T4 group showed a significant absence of CS after 1, 6, and 12 months after surgery (p<0.001).Moreover, there was no severe CS in T4 group after 12 months (p=0.039).There was a higher satisfaction rate in T4 group (p=0.004).Conclusion: Both treatments were effective in controlling primary axillary hyperhidrosis.The T4 group demonstrated less severe compensatory sweating and higher satisfaction rates.