Invited Commentary

Excerpt

Primary hyperhidrosis is much more common than previously thought. The projected prevalence is almost 3% in North America, equivalent to 7.8 million inhabitants [1]. Patients who seek therapy are disabled by their symptoms, both professionally and socially, and if medical management fails, surgery may be effective. It is generally accepted that upper thoracic sympathectomy is the treatment of choice, and this procedure is performed in thousands of patients each year by general surgeons, neurosurgeons, thoracic surgeons, or vascular surgeons. Since the introduction of video assisted thoracoscopy in the 1980s the number of procedures has increased tremendously, and given the high prevalence of primary hyperhidrosis it is likely to increase even further. Patients who have been sweating severely enough to cause significant occupational or social difficulties and who have been cured by sympathectomy are among the most grateful that surgeons will encounter in the course of their work [2]. Most patients describe their life as “completely changed” by the operation, even though there are well-known side effects. Because primary hyperhidrosis is a benign disorder it is crucial to discuss these side effects thoroughly with the patient before considering sympathectomy. …