Long-Term Outcomes and Predictors of Compensatory Sweating After Bilateral Endoscopic Thoracic Sympathectomy

This study analyzed long-term risk factors for compensatory sweating following bilateral endoscopic thoracic sympathectomy (BETS) in 98 patients between 2010 and 2023. Compensatory sweating as a side effect was classified as mild, moderate, or severe using the STS guidelines, while quality of life (QOL) was assessed via the Hyperhidrosis Disease Severity Scale. Logistic and Bayesian regression models were used to identify predictors of compensatory sweating. 
 
Overall, the procedure achieved a success rate of 94.38 percent, with 34.69 percent of patients reporting compensatory sweating, mostly mild (26.53 percent). Nearly all patients achieved significant reduction in sweating (≥50 percent in 97.95 percent; ≥80 percent in 94.89 percent). 
 
Protective factors highlighted were high hemoglobin levels and marijuana use. Conversely, tobacco smoking and the presence of combined hand-axillary hyperhidrosis increased the risk of compensatory sweating. Identifying at-risk patients, such as those who smoke tobacco and those with low hemoglobin levels, can help improve outcomes by managing expectations when undergoing (BETS).