Background: Primary hyperhidrosis (PHH) is characterized by sweating more than physiologic need for thermoregulation in certain parts of body without a known cause, for a period of at least six months. Surgical methods such as sympathicotomy are efficient and permanent treatments for PHH.

Objectives: This study was planned to evaluate and compare complications and patients’ satisfaction of thoracoscopic sympathicotomy in levels of R2-R4 versus R3-R5 for PHH treatment.

Patients and Method: From March 2010 to January 2013, a prospective single-blinded randomized study was performed on 94 patients with PHH in two groups, which were treated by thoracoscopic R2-R4 (group A) and R3-R5 (group B) sympathicotomies. The patients were evaluated at the first week and at least after six months postoperatively for outcomes, complications and satisfactions. Collected data were analyzed by SPSS version 18 using Student T test and Chi-square test.

Results: In a total of 94 patients, 73 (77.7%) were men and 21 (22.3%) were women. Their mean age was 26.5 ± 6.5 years. Thoracoscopic R2-R4 sympathicotomy was done in 47 patients (group A) and thoracoscopic R3-R5 sympathicotomy was also done in 47 patients (group B). Early compensatory sweating (CS) were 78.7% and 66.0% in groups A and B (P = 0.167). The rates of late compensatory sweating were 74.4% (group A) and 70.7% (group B) (P = 0.241). Early and late postoperative satisfactions were 98.6% and 98.2% in group A and 97.9% and 97.3% in group B, respectively (P > 0.05). There were no statistical significant differences between two groups in early and late CS and postoperative satisfactions. The Rates of other early and late complications, such as pneumothorax, hemorrhage, hemothorax, and infection, were lower in group B. (P = 0.006 and P = 0.005)

Conclusions: Thoracoscopic sympathicotomy shows proper results in treatment of PHH. Thoracoscopic R3-R5 sympathicotomy compared with R2-R4 sympathicotomy is a preferable method, because of similar results and fewer complications.