Best Location for Sympathectomy

In a recent paper published in the Annals of Surgery the debate over the best location for sympathectomy has been rekindled. As it is known by now doing sympathectomy at the T2 level for patients with severe excessive hand sweating (palmar hyperhidrosis) is not recommended anymore by the majority the experienced surgeons in this field. As stated previously performing ETS at T3 or T4 levels provides the same good results of dry hands but with a lesser incidence of severe compensatory sweating.

In previous meetings of the International Society of Sympathetic Surgery there were some attempts to promote sympathectomy at even a lower level such as T4 to T5.

Dr. Reisfeld had tried this but the level of dryness achieved was not satisfactory enough to the patients as well as too Dr. Reisfeld himself. That is why it is the policy of the Center for Hyperhidrosis to continue and perform ETS at the T3-T4 level. If a patient is familiar with this topic then upon request T4-T5 sympathectomy can be carried out with the understanding that the level of dryness may not be as complete as the T3-T4 level.

The paper concluded that doing sympathectomy at the T4-T5 level will produce less compensatory sweating however in Dr. Reisfeld’s opinion there needs to be longer follow-ups and a larger number of patients to make this statement.

Also have a look at our hyperhidrosis frequently asked questions page.