Aim: Hyperhidrosis is excessive sweating beyond physiologic needs resulting in profuse sweating of the 
palms, axillae, feet, and face. Endoscopic transthoracic sympathicotomy is a popular surgical technique to 
treat primary hyperhidrosis; the aim of this study is to assess the effectiveness of limited T4 
sympathicotomy for alleviating palmar hyperhidrosis and preventing compensatory hyperhidrosis. 
Methods: This study was conducted in General and Vascular Surgery Unit at Mansoura University Hospital 
in the period from February 2008 to January 2011 on 78 patients. All patients complained of palmar 
hyperhidrosis, 15 of them complained also from axillary hyperhidrosis, T4 sympathicotomy by diathermy 
was done to all patients (T5 sympathicotomy was also done with T4 in patients suffering from axillary 
hyperhidrosis).
Results: One hundred and fifty six sympathicotomies were consecutively done in 78 patients. The mean age 
was (22.6±5.2 years) and there were 48 females and 30 males. 24 patients (30.8%) had family history of 
hyperhidrosis. Mean operative time was (35±7 minutes). No recurrence, no compensatory hyperhidrosis 
were observed in all patients .minor Complications were occurred in three patients (Pneumothorax in one 
patient and segmental atelectasis in two patients). All patients are satisfied with the operation. In addition, 
an improvement in the quality of life was seen starting from the first postoperative evaluation and 
maintained until the end of the follow up. 
Conclusion: Limited T4 blockade is an easy, safe and effective treatment for patients with primary palmar 
hyperhidrosis without postoperative reflex sweating.