Evidence-Based Review of the Surgical Management of Hyperhidrosis

The authors have systematically reviewed the evidence supporting thoracic sympathectomy in the management of patients with primary hyperhidrosis. Substantive observational literature suggests that endoscopic thoracic sympathectomy is a safe and effective therapeutic strategy in patients with hyperhidrosis, with excellent long-term results and high rates of patient satisfaction. However, randomized, controlled trials directly comparing sympathectomy with alternative treatments are lacking in this patient population. Adequately powered clinical trials are needed to elucidate the role of sympathectomy in the face of emerging nonsurgical therapies and may help identify subsets of patients most likely to benefit from surgical intervention.