Endoscopic thoracic sympathectomy or sympathicotomy versus clipping in the surgical management of primary hyperhidrosis: a systematic review and meta-analysis

Background: Primary hyperhidrosis is characterized by excessive sweating in distinct parts of the body. Surgery appears to be the best strategy considering the limited invasiveness of modern techniques. In this work, we compared the excision of main sympathetic trunk with ganglia (sympathectomy) or the interruption of sympathetic chain (sympathicotomy) with the positioning of metal clips. Methods: A research via PubMed, including published articles between 2009 and 2019, was carried out. Meta-analysis was performed by combining the reported recurrence/failure and compensatory sweating outcomes of the individual studies using a random effect model. Results: Of the one hundred and twenty-five articles identified, only 9 are considered valid for meta-analysis with overall information on 2,206 patients treated for primary hyperhidrosis. For the compensatory hyperhidrosis, despite a considerable data heterogeneity, we found a stronger correlation with the endoscopic sympathectomy/sympathetic procedure compared to clipping (odds ratio of 0.62). For the recurrence/failure of treatment, although the same heterogeneity of the data, we highlighted a strong correlation with the clipping procedure compared to endoscopic sympathectomy/sympathicotomy (odds ratio of 2.35). Conclusions: Sympathectomy or sympathicotomy have instead proved to be a safe and effective technique, with a low rate of recurrences. Clipping showed a reduced percentage of compensatory sweating but the removal of device is never easy, exposing patients to higher risks of open approach.