Achieving high patient satisfaction after sympathectomy through preoperative thoracoscopic sympathetic nerve block in primary hyperhidrosis

Background: Compensatory hyperhidrosis (CH) is a frequent complication following sympathectomy, influencing patient satisfaction. This study was established to evaluate the impact of bilateral thoracoscopic sympathetic nerve block (TSNB) on patient satisfaction after sympathectomy in the treatment of primary hyperhidrosis. Methods: From March 2021 to August 2023, 52 patients with primary palmar and craniofacial hyperhidrosis underwent TSNB at T3 using a 2-mm thoracoscope under local anesthesia. One week later, they decided whether to proceed with sympathectomy. Satisfaction was assessed using a 100-point scale, and patients were divided into two groups based on CH occurrence after sympathectomy. The groups were compared in terms of sex, age, hyperhidrosis site, and satisfaction scores. Results: Among 52 patients who underwent TSNB, 35 (67.31%) proceeded to sympathectomy, and CH occurred in 18 (51.43%) of these patients, while the remaining 17 patients (48.57%) did not develop CH. No significant differences were observed between the CH and no-CH groups regarding age (26.61±9.02 vs. 25.41±10.09 years, P=0.66), sex (61.11% vs. 52.94% male, P=0.88), or primary hyperhidrosis site (palmar: 77.78% vs. 88.24%, P=0.66). Satisfaction scores were comparable between the CH group (92.50±7.33) and the no-CH group (96.18±4.52), with no statistically significant difference (P=0.15). Conclusions: Sympathectomy is associated with a high incidence of CH. Through TSNB, patients could preoperatively experience potential effects, including CH, enabling informed surgical decisions. Patients who developed CH reported high satisfaction levels comparable to those without CH, underscoring the utility of TSNB in improving patient-centered outcomes.