"From One Problem to Another, Comparing the Incidence of Compensatory Hyperhidrosis After T3 Vs. T3-4 Sympathectomy"

Primary hyperhidrosis is a chronic condition characterized by excessive sweating beyond physiological needs, commonly affecting the palms, axillae, face, or soles. This disorder is largely attributed to neurogenic hyperexcitability within the sympathetic nervous system's pathways innervating the eccrine sweat glands.When conservative treatments such as topical agents or oral medications fail, endoscopic thoracic sympathectomy (ETS) is considered an effective surgical option. However, a major postoperative complication is compensatory hyperhidrosis (CH)-the development of excessive sweating in previously unaffected areas such as the trunk, back, or thighs. CH can significantly impact patient satisfaction and quality of life, often becoming more distressing than the original condition.

The extent and level of sympathectomy have been proposed as key factors influencing the incidence and severity of CH. While higher levels or multilevel resections (e.g., T2-4) are associated with increased rates of CH, more limited approaches such as T3-only resection are thought to reduce this risk. However, definitive evidence comparing T3 versus T3-4 sympathectomy remains limited and inconsistent across studies.

This study aims to compare the incidence and severity of compensatory hyperhidrosis following T3 versus T3-4 sympathectomy for primary hyperhidrosis. Understanding these differences may help refine surgical approaches to minimize CH and improve patient outcomes.