الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Primary hyperhidrosis is not an uncommon disease that is characterized by excessive sweating beyond that required to maintain the normal temperature of the body. Its exact mechanism of action is still poorly identified. Its incidence is about 2% of the people worldwide and it may have a genetic component.
There is no gender difference regarding its incidence. It starts mainly in adolescence, with an underrated incidence because of the feeling of shame felt by patients. Moreover, it has a great adverse effect on the life of the affected persons because of problems in their social lives.
There are different modalities to treat primary hyperhidrosis. The medical therapy includes topical, oral and injectable therapies. Topical therapies contain antiperspirants and topical glycopyrrolate 2%. The oral therapies contain oral anticholinergics as oxybutynin. Injectable therapy could be achieved by the administration of the botulinum toxin at the locations affected by hyperhidrosis. However, surgery is considered now the best modality of treatment as it is a minimally invasive technique with good results. The exclusion of sympathetic chain and ganglia is done through the interruption of sympathetic trunk through sympathectomy at specific various levels.
The aim of the current study was to evaluate and to assess the compensatory sweating following VATS sympathectomy for the treatment of primary palmar hyperhidrosis at two different levels T2-3 versus T2-4 regarding the incidence, site, severity and patient satisfaction.
This prospective and randomized clinical study involved a total of 50 eligible consecutive patients suffering from primary palmar hyperhidrosis managed by bilateral, bi-portal and tubeless thoracoscopic approach with conventional general anesthesia. group A represents Twenty five patients who had sympathetic chain cutting at the level of T2-3 and group B represents twenty five patients who had sympathetic chain cutting at the level of T2-4. All patients had bilateral primary hyperhidrosis.
There was no intraoperative complication in both groups. However, one patient (2%) in group B had a post-operative complication which was superficial wound infection which was simple and treated easily by frequent dressing.
Ninety-eight percent of patients, in both groups, showed postoperative complete dryness of the hand and improvement of their symptoms.
Between both groups, there was a statistically significant difference regarding the degree of severity of compensatory sweating post-operatively between both groups. In group A 44 % of patients had CS, while in group B 96 % of patients had symptoms of CS with varying degrees from 1 to 5 on VAS-Score of five degrees. Therefore, the more the level is cauterized, the more the compensatory sweating is occurred.
In term of patient’s satisfaction, the main issue was about irreversibility of compensatory sweating, which causes some patients to be unsatisfied. It was obvious that group A is more satisfied (92 %) than group B (52%) as they had less compensatory sweating.