Effectiveness of Bilateral Clipping of the Thoracic Sympathetic Chain for the Treatment of Severe Palmar and/or Axillary Hyperhidrosis and Facial Flushing

Abstract Introduction Division of the thoracic sympathetic chain is the standard treatment for severe palmar and/or axillary hyperhidrosis and facial flushing. Clipping is an alternative option which allows the block to be reverted in cases of intolerable compensatory sweating. Methods This is a prospective study performed to assess: (a) results of clipping of the thoracic sympathetic chain in patients with palmar and/or axillary hyperhidrosis and facial flushing; and (b) to determine the improvement obtained after removal of the clip in patients with unbearable compensatory sweating. We included 299 patients (598 procedures) diagnosed with palmar hyperhidrosis ( n =110), palmar and/or axillary hyperhidrosis ( n =78), axillary hyperhidrosis ( n =35), and facial flushing ( n =76), who underwent videothoracoscopic clipping between 2007 and 2015. Results 128 men and 171 women were treated, with mean age of 28 years. A total of 290 patients (97.0%) were discharged within 24 h. The procedure was effective in 92.3% (99.1% in palmar hyperhidrosis, 96.1% in palmar and/or axillary hyperhidrosis, 74.3% in axillary hyperhidrosis, and 86.8% in facial flushing). Nine patients (3%) presented minor complications. Compensatory sweating developed in 137 patients (45.8%): moderate in 113 (37.8%), severe in 16 (5.3%) and unbearable in 8 (2.7%). The clip was removed in these 8 patients; symptoms improved in 5 (62.8%), with sustained effect on hyperhidrosis in 4 of them. Conclusions Clipping of the thoracic sympathetic chain is an effective and safe procedure. If incapacitating compensatory sweating develops, this technique allows the clips to be removed with reversion of symptoms in a considerable number of patients.