Sympathetic Ablation for Primary Palmar Hyperhidrosis: Could Controversies be solved?

Excessive perspiration of the palms of unknown etiology is present in a substantial number of the young people. It may cause severe social, emotional and occupational handicaps. A multitude of therapies exist, but sympathetic ablation is the only method that may obtain permanent relief. Sympathectomy, however, is not devoid of consequences, compensatory hyperhidrosis (increase in perspiration in areas of the body unaffected by the sympathetic ablation) is the most important and may attain devastating proportions. With the advent of thoracoscopic surgery, several modifications of the standard T2-T3 ablation were introduced. It was postulated that lowering the level of ablation and reducing its extent would attenuate the amount of compensatory hyperhidrosis. Instead of excision, transection of the sympathetic chain or ganglionic electrocoagulation became popular. Published data are, however, still controversial. To resolve the dilemmas, well designed studies are required, in which only one variable is evaluated, the exact level of ablation is marked (and postoperatively confirmed by chest radiograph), the level of ablation is ganglion, not rib, based, and results are quantitatively assessed. A standard questionnaire for data compilation has been developed by the International Society of Sympathetic Surgery, which is willing to assist and promote such studies.