Analysis of causes of postoperative recurrence of palmar hyperhidrosis and summary of reoperation experience in 36 patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DU Quan ^1,2 , WANG Zijie ³ , LIN Min ^1,2 ,  TU Yuanrong ^1,2 ,  CHEN Jianfeng ^1,2

1. Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, P. R. China;
2. Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University (Binhai Campus), National Regional Medical Center, Fuzhou, 350212, P. R. China;
3. The First Clinical Medical College of Fujian Medical University, Fuzhou, 350122, P. R. China;

Corresponding?author：

TU Yuanrong, Email: tuyuanrong@hotmail.com; CHEN Jianfeng, Email: 282781840@qq.com

Keywords：

Thoracoscopy; sympathectomy; recurrence palmar hyperhidrosis; reoperation

DOI：

10.7507/1007-4848.202508057

Video：

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Objective To investigate the causes of postoperative recurrence in patients with palmar hyperhidrosis and summarize the experience of reoperation. Methods Clinical data were collected from patients who experienced recurrence after surgical treatment for palmar hyperhidrosis at other hospitals between 2020 and 2023, and were admitted to the First Affiliated Hospital of Fujian Medical University. All patients underwent endoscopic thoracic sympathectomy (ETS) using a two-port thoracoscopy technique under artificial pneumothorax. The causes of recurrence and outcomes of reoperation were analyzed. Results A total of 36 patients (15 males, 21 females) with an average age of (28.25±6.14) years were included. The operative duration was 24-47 (31.04±21.09) minutes. No intraoperative bleeding, postoperative pneumothorax, or Horner's syndrome occurred. Two patients required intraoperative placement of closed thoracic drainage tubes due to severe pleural adhesions. All patients were discharged uneventfully on postoperative day 1. Intraoperative findings revealed the following primary causes of recurrence: incomplete transection of the sympathetic trunk, actual transection level lower than documented during initial surgery, failure to transect adjacent vessels paralleling the nerve trunk, insufficient resection range of lateral branches, and distance between nerve stumps <1 cm. At 1-year follow-up, all patients maintained bilateral hand dryness without recurrence, achieving a 100.0% efficacy rate. However, 15 patients developed new-onset or worsened compensatory hyperhidrosis compared to preoperative status. Conclusion ETS is a safe, feasible, and effective treatment modality for recurrent palmar hyperhidrosis.

1.	Tu YR, Li X, Lin M, et al. Epidemiological survey of primary palmar hyperhidrosis in adolescent in Fuzhou of People's Republic of China. Eur J Cardiothorac Surg, 2007, 31(4): 737-739.
2.	Wade R, Llewellyn A, Jones-Diette J, et al. Interventional management of hyperhidrosis in secondary care: A systematic review. Br J Dermatol, 2018, 179(3): 599-608.
3.	Kristensen JK, Nielsen C. Progress and lack of progress in hyperhidrosis research 2015-2020. A concise systematic review. Int J Dermatol, 2022, 61(2): 148-157.
4.	涂遠榮, 劉彥國. 中國手汗癥微創治療臨床指南(2021年版). 中華胸心血管外科雜志, 2021, 27(8): 449-451.Tu YR, Liu YG. Clinical Guidelines for Minimally Invasive Treatment of Palmar Hyperhidrosis in China (2021 Version). Chin J Thorac Cardiovasc Surg, 2021, 27(8): 449-451.
5.	Liu Y, Weng W, Tu Y, et al; Chinese Expert Committee on Palmar Hyperhidrosis. Chinese expert consensus on the surgical treatment of primary palmar hyperhidrosis (2021 version). Chin Med J (Engl), 2022, 135(11): 1264-1271.
6.	Connolly M, De Berker D. Management of Primary Hyperhidrosis: A Summary of the Different Treatment Modalities. Am J Clin Dermatol, 2003, 4(10): 681-697.
7.	Chen J, Liu Y, Yang J, et al. Endoscopic thoracic sympathicotomy for primary palmar hyperhidrosis: A retrospective multicenter study in China. Surgery, 2019, 166(6): 1092-1098.
8.	Lin TS. Video-assisted thoracoscopic "resympathicotomy" for palmar hyperhidrosis: analysis of 42 cases. Ann Thorac Surg, 2001, 72(3): 895-898.
9.	Park HS, Hensman C, Leong J. Thoracic sympathetic nerve reconstruction for compensatory hyperhidrosis: the Melbourne technique. Ann Transl Med, 2014, 2(5): 45.
10.	Han JW, Kim JJ, Kim YH, et al. New sympathicotomy for prevention of severe compensatory hyperhidrosis in patients with primary hyperhidrosis. J Thorac Dis, 2020, 12(3): 765-772.
11.	García-Barquín P, Aquerreta Beola JD, Bondía Gracía JM, et al. Percutaneous CT-guided sympathicolysis with radiofrequency for the treatment of palmar hyperhidrosis. J Vasc Interv Radiol, 2017, 28(6): 877-885.
12.	Hasimoto FN, Cataneo DC, Hasimoto EN, et al. Radiofrequency in the treatment of primary hyperhidrosis: systematic review and meta-analysis. Clin Auton Res, 2020, 30(2): 111-120.
13.	Koura MA, Attwa IS. Effect of Radiofrequency Ablation and Comparison With Surgical Sympathectomy in Palmar Hyperhidrosis. Cureus, 2025, 17(7): e88543.
14.	Hsu CP, Chen CY, Hsia JY, et al. Resympathectomy for palmar and axillary hyperhidrosis. Br J Surg, 1998, 85(11): 1504-1505.
15.	Xu Y, Fei X, Fu H, et al. Upregulated expression of a TOR2A gene product-salusin-β in the paraventricular nucleus enhances sympathetic activity and cardiac sympathetic afferent reflex in rats with chronic heart failure induced by coronary artery ligation. Acta Physiol (Oxf), 2023, 238(4): e13987.

1. Tu YR, Li X, Lin M, et al. Epidemiological survey of primary palmar hyperhidrosis in adolescent in Fuzhou of People's Republic of China. Eur J Cardiothorac Surg, 2007, 31(4): 737-739.
2. Wade R, Llewellyn A, Jones-Diette J, et al. Interventional management of hyperhidrosis in secondary care: A systematic review. Br J Dermatol, 2018, 179(3): 599-608.
3. Kristensen JK, Nielsen C. Progress and lack of progress in hyperhidrosis research 2015-2020. A concise systematic review. Int J Dermatol, 2022, 61(2): 148-157.
4. 涂遠榮, 劉彥國. 中國手汗癥微創治療臨床指南(2021年版). 中華胸心血管外科雜志, 2021, 27(8): 449-451.Tu YR, Liu YG. Clinical Guidelines for Minimally Invasive Treatment of Palmar Hyperhidrosis in China (2021 Version). Chin J Thorac Cardiovasc Surg, 2021, 27(8): 449-451.
5. Liu Y, Weng W, Tu Y, et al; Chinese Expert Committee on Palmar Hyperhidrosis. Chinese expert consensus on the surgical treatment of primary palmar hyperhidrosis (2021 version). Chin Med J (Engl), 2022, 135(11): 1264-1271.
6. Connolly M, De Berker D. Management of Primary Hyperhidrosis: A Summary of the Different Treatment Modalities. Am J Clin Dermatol, 2003, 4(10): 681-697.
7. Chen J, Liu Y, Yang J, et al. Endoscopic thoracic sympathicotomy for primary palmar hyperhidrosis: A retrospective multicenter study in China. Surgery, 2019, 166(6): 1092-1098.
8. Lin TS. Video-assisted thoracoscopic "resympathicotomy" for palmar hyperhidrosis: analysis of 42 cases. Ann Thorac Surg, 2001, 72(3): 895-898.
9. Park HS, Hensman C, Leong J. Thoracic sympathetic nerve reconstruction for compensatory hyperhidrosis: the Melbourne technique. Ann Transl Med, 2014, 2(5): 45.
10. Han JW, Kim JJ, Kim YH, et al. New sympathicotomy for prevention of severe compensatory hyperhidrosis in patients with primary hyperhidrosis. J Thorac Dis, 2020, 12(3): 765-772.
11. García-Barquín P, Aquerreta Beola JD, Bondía Gracía JM, et al. Percutaneous CT-guided sympathicolysis with radiofrequency for the treatment of palmar hyperhidrosis. J Vasc Interv Radiol, 2017, 28(6): 877-885.
12. Hasimoto FN, Cataneo DC, Hasimoto EN, et al. Radiofrequency in the treatment of primary hyperhidrosis: systematic review and meta-analysis. Clin Auton Res, 2020, 30(2): 111-120.
13. Koura MA, Attwa IS. Effect of Radiofrequency Ablation and Comparison With Surgical Sympathectomy in Palmar Hyperhidrosis. Cureus, 2025, 17(7): e88543.
14. Hsu CP, Chen CY, Hsia JY, et al. Resympathectomy for palmar and axillary hyperhidrosis. Br J Surg, 1998, 85(11): 1504-1505.
15. Xu Y, Fei X, Fu H, et al. Upregulated expression of a TOR2A gene product-salusin-β in the paraventricular nucleus enhances sympathetic activity and cardiac sympathetic afferent reflex in rats with chronic heart failure induced by coronary artery ligation. Acta Physiol (Oxf), 2023, 238(4): e13987.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesAnalysis of causes of postoperative recurrence of palmar hyperhidrosis and summary of reoperation experience in 36 patients

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