Compensatory Hyperhidrosis Following Endoscopic Thoracic Sympathectomy: A 5-Year Follow-Up Study of Risk Factors and Symptom Progression

Background Compensatory hyperhidrosis (CH) is a common complication after endoscopic thoracic sympathectomy (ETS) for hyperhidrosis. Despite its prevalence, long-term data on CH progression and associated risk factors are scarce. This study evaluates the risk factors and progression of CH during a 5-year follow-up period. Methods This study retrospectively analyzed 138 patients with primary palmar hyperhidrosis (PPH) who underwent endoscopic thoracic sympathectomy between January 2014 and December 2019. All patients underwent bilateral single-port thoracoscopic sympathectomy and were followed up at 1, 3, and 5 years postoperatively. The severity of postoperative sweating was assessed using the Hyperhidrosis Disease Severity Scale (HDSS). Univariate and multivariate logistic regression analyses were performed to identify the risk factors associated with the development and progression of CH. Results A total of 138 patients were included in the study, with 78.9% reporting the occurrence of CH after surgery and 23.8% of them experiencing severe CH. HDSS scores increased over the 5 years postoperatively, with symptoms worsening. Further analysis revealed that bilateral R4-level sympathectomy significantly increased the risk of CH progression (OR = 4.28, 95% CI: 1.27–15.60, P = 0.021) while having three or more affected areas was identified as a protective factor (OR = 0.19, 95% CI: 0.05–0.63, P = 0.008). Conclusion This study found that compensatory hyperhidrosis is relatively common in patients undergoing ETS, and symptoms may progressively worsen over time. The level of sympathetic nerve resection and the number of affected areas are key predictive factors for worsening symptoms.