Surg Today (2000) 30:1089–1092 The Effect of Upper Dorsal Thoracoscopic Sympathectomy on the Total Amount of Body Perspiration Doron Kopelman, Ahmad Assalia, Marina Ehrenreich, Yuval Ben-Amnon, Hany Bahous, and Moshe Hashmonai Department of Surgery B, Rambam Medical Center and Faculty of Medicine, Technion — Israel Institute of Technology, P.O. Box 9602, Haifa 31906, Israel Introduction Primary palmar hyperhidrosis (PPH) is a pathological condition of excessive perspiration of unknown etiology which may result in severe occupational, emotional, and social handicaps at an early age. An epidemiological study revealed that 0.15%–0.25% of the young popu- lation in Israel 1 have severe palmar sweating. The contemporary treatment of choice is surgical thoraco- scopic upper dorsal sympathectomy (TUDS) 2,3 and although excellent results are being achieved, 3 TUDS is not devoid of complications and sequelae. 4,5 The so- called compensatory hyperhidrosis (CH), which mani- fests as increased perspiration in other parts of the body, is the most frequently reported complication, occurring in up to 85% of patients who undergo this procedure, 5 and the most severe of all postsympathectomy sequelae. 6 It is considered to be a compensatory thermoregulating mechanism, 7,8 in that the total amount of perspiration is unchanged by sympathectomy, but the sweating area is decreased. 9 CH does not develop in all patients, 5 and does not necessarily present immediately, but may appear even as late as 6 months postoperatively; 8 the degree of CH is variable; 10 and it may be alleviated or abate spontaneously. 7,11 Furthermore, the opposite effect, namely, decreased sweating in other parts of the body, has also been reported following sympathec- tomy. 11–14 Thus, the mechanism of this phenomenon appears to be more complex than simple compensation for thermoregulatory purposes, and remains obscure. The present study was conducted to evaluate the changes in total body perspiration caused by heat stress in patients who underwent TUDS for PPH. Materials and Methods During the period between January 1, 1996, and March 31, 1998, we performed 51 bilateral thoracoscopic Abstract Thoracoscopic T 2 –T 3 sympathectomy is the treatment of choice for primary palmar hyperhidrosis (PPH); however, compensatory hyperhidrosis (CH) is a disturbing sequela of this operation, the mechanism of which is poorly understood. This study was conducted to evaluate the effect of heat stress on total body per- spiration after thoracoscopic T 2 –T 3 sympathectomy, and determine its correlation with CH. A total of 17 patients with PPH who underwent bilateral T 2 –T 3 sympathec- tomy were subjected to heat stress induced by a 10-min sauna bath (ambient temperature 70°C), 1 day before and 1 month after surgery. The naked body weight was recorded before and immediately following the sauna bath, and the patients were followed up to assess whether CH had developed and the degree of its severity. Postoperatively, the amount of perspiration increased in 13 patients and decreased in 1. The amount of perspiration induced by the sauna bath ranged from 60 to 480 g, with a mean value of 185.29  125.80 g, before the operation, and from 60 to 540 g, with a mean value of 265.88  154.05 g, after the operation (P = 0.0113). There was no correlation between the degree of alteration in total body perspiration and the devel- opment of CH. Performing thoracoscopic T 2 –T 3 sym- pathectomy for PPH affects the total body sweating response to heat; however, the development of CH does not correlate with this alteration. Key words Palmar hyperhidrosis · Thoracoscopic sympathectomy · Compensatory hyperhidrosis Reprint requests to: M. Hashmonai Received: November 29, 1999 / Accepted: July 25, 2000