Thoracic sympathectomy for the treatment of primary axillary hyperhidrosis: systematic review and proportional meta-analysis

Introduction Primary hyperhidrosis is a disorder that involves excessive sweat production, which has a negative impact on the quality of life. Objective To evaluate the effectiveness and safety of video-assisted thoracoscopic sympathectomy (VATS) for treating primary axillary hyperhidrosis (PAH) and determine which level of ganglion resection offers the best outcome. Method This was a systematic review and proportional meta-analysis of observational studies. The result was evaluated for satisfaction, control of symptoms, compensatory sweating and complications. A subgroup analysis was performed to compare the sympathetic trunk resection at high and low levels. Results Thirteen studies were selected with a total of 1463 patients. The satisfaction rate was 92% (95% CI = 88-95%, I (2)=47.5%), the symptom control rate was 96% (95% CI = 93-99%, I (2)=48.2%), and the presence of compensatory sweating could not be assessed because of high heterogeneity among studies. The complications were rare. Conclusion This review demonstrated that thoracic sympathectomy by VATS is a viable and safe option for the treatment of PAH. There was no difference between high and lower levels of resection. However, the estimation of the effect is quite uncertain because the quality of evidence was extremely low. Key message Pure axillary hyperhidrosis has great potential to compromise quality of life. Surgery should be indicated only when clinical treatment fails. Thoracic sympathectomy by video-assisted thoracoscopy is a viable and safe option for the treatment of primary axillary hyperhidrosis.