Influence of sex on the outcomes of uniportal video‑assisted thoracoscopic sympathicotomy for primary palmar hyperhidrosis.

Introduction: Primary palmar hyperhidrosis (PPH) impairs the quality of life. Video‑assisted thoracoscopic sympathicotomy is an effective treatment method; however, the impact of sex on surgical outcomes accord‑ ing to the denervation level (T3 vs T3-T4 sympathicotomy) remains unclear.AIM This study investigated the efficacy, complications, and symptom relief rates of isolated T3 vs combined T3-T4 sympathicotomy for PPH, focusing on sex differences.

Materials and methods: A retrospective analysis of 327 patients undergoing bilateral uniportal video‑assisted thoracoscopic sympathicotomy for PPH between 2012 and 2022 was performed. The patients were divided into 2 groups depending on the procedure type (isolated T3 sympathicotomy [n = 167] vs T3-T4 combined sympathicotomy [n = 160]). Demographic data, procedure outcomes, and complications were compared.

Results: Success rates were 95.8% in the T3 sympathicotomy group and 93.8% in the T3-T4 sympathicotomy group, with no significant difference. The most common complication was dryness of the hands. The overall complication rate was lower in the T3 than in the T3-T4 sympathicotomy group (9.6% vs 14.4%; P = 0.04). Compensatory sweating occurred in 2.4% and 3.1% of the participants in the T3 and T3-T4 sympathicotomy groups, respectively (P = 0.52). The frequency of compensatory sweating, chest pain, and dryness of the hands was significantly higher in men. Age, sex, and duration of surgery had no independent influence on the occurrence of complications.

Conclusions: Isolated T3 sympathicotomy is an effective and safe option for the treatment of PPH, and is associated with fewer complications than combined T3-T4 sympathicotomy. Higher complication rates in men emphasize the need for sex‑specific surgical planning and patient counseling.