A comparison of T3 sympathectomy versus T4 sympathectomy in the treatment of primary palmer hyperhidrosis

Objective To evaluate the effect and side effect of T_3 versus T_4 sympathicotomy in the surgical management of primary palmar hyperhidrosis through prospective multi-center randomized controlled trial.Methods From Sep 2004 to Feb 2006,106 consecutive patients (49 males and 54 females) with primary palmar hyperhidrosis were enrolled in the study and randomly assigned into T_3 or T_4 level sympathicotomy groups.66 patients received T_3 sympathetic chain transection and 37 patients received T_4 sympathetic chain transection.The two groups were comparable in all other parameters.Results All procedures were carried out successfully without severe morbidity or mortality.After a mean follow-up period of 8.6 months,both groups remained satisfactory in palmar sweating control.The T_4 group had more moisture hands compared with the T_3 branch (54.1% vs 15.2%,P0.01),but this didn't compromise the patients' satisfactory.The patients in T_4 group showed significantly less dry hand problems than the patients in the T_3 group (5.4% vs.25.8%,P0.05),and so did compensatory sweating (21.6% vs. 45.6%,P0.05).Conclusion The procedure of T_3 or T_4 sympathicotomy,both transecting the sympathetic chain in one single position in relatively lower segment,are comparatively effective in the treatment of primary palmar hyperhidrosis,but T_4 sympathicotomy shows less side effect.