Thoracoscopic sympathectomy for primary hyperhidrosis

Hyperhidrosis is defined as excessive sweating beyond the physiologic need in response to thermal and emotional stimuli. It is either primary or secondary to other diseases as hyperthyroidism, pheochromocytoma or other diseases. It is usually localized to hands, axilla, face or feet but may sometimes be generalized. It is a benign disease with disabling social consequences and a well-defined burden to the patient own social and professional life. The incidence of hyperhidrosis is reported as approximately 2.8% of western world population with peak incidence at the late second and early third decades of life. The incidence in men and women is the same. However, women are more likely to seek medical advice, which may explain the higher incidence of female patients in most surgical series. The pathoetiology of this condition is still obscure, however, a genetic factor is clerly involved in many cases since 50% of the patients have relatives with hyperhidrosis. Hypertrophy of sweat glands has been observed in hyperhidrotic subjects in one study, but this finding has not been confirmed in others. Various authors have reported abnormalities of sympathetic Sudomotor Skin Response (SSR) in patients with primary hyperhidrosis. Sympathetic skin response may be either absent or abnormally large in some patients with primary palmar hyperhidrosis. Primary hyperhidrosis not only causes social, psychological and occupational problems, but also it increases the risk of cutaneous infection by either bacterial, fungal and viral pathogens. Eczematous dermatitis commonly coexists. So, management of hyperhidrosis may have secondary benefit of decreasing this risk. Diagnosis of primary hyperhidrosis should be made only after exclusion of secondary causes of excessive sweating. It is focal excessive sweating of at least 6 months without apparent cause. It is bilateral, relatively symmetric