Comparison Between Modified Wittmoser Method and Conventional Thoracoscopic Sympathectomy in Treating Patients with Primary Hyperhidrosis

Background: Although thoracoscopic sympathectomy is a documented safe and effective procedure in the management of hyperhidrosis patients, some patients may develop compensatory sweating or recurrence after the procedure. That is why surgeons always seek modification of the conventional thoracoscopic procedure to obtain better outcomes. Herein, we evaluated the advantages of the modified Wittmoser technique (division of the rami communicants and interganglionic fibers) compared to the conventional one in patients with primary hyperhidrosis. Methodology: Fifty patients met our criteria and were divided into two groups: Group A had the conventional technique, and Group B had the modified Wittmoser technique. Follow-up was done for six months after the procedure. Results: The modified Wittmoser technique was associated with a significant prolongation of operative time. Both approaches led to a significant decline in the sweating severity in the affected regions. However, the incidence of compensatory hyperhidrosis was significantly higher in the conventional group (32% vs. 4% in the Wittmoser group). Although both groups expressed significant improvement in their quality of life (QOL), that improvement was more noticeable in the Wittmoser group. The incidence of early complications, pain scores, and hospitalization periods were comparable between the two approaches. No patients developed recurrence within the six-month follow-up period. Conclusion: Although the conventional sympathectomy technique is safe and effective in managing hyperhidrosis patients, the use of the modified Wittmoser technique had some advantages manifested mainly in the decreased incidence of compensatory sweating and the better improvement in the QOL.