Hyperhidrosis, local or generalized, is an unpleasant disease which causes the affected subjects serious psychosocial problems. Secondary hyperhidrosis is an associated symptom of various pathological conditions. In the submitted paper the authors analyze above all the primary idiopathic form the most probable cause of which is vegetative disbalance. At present in treatment conservative local procedures predominate such as various ointments, powders and more recently iontophoresis or intradermal administration of botulotoxin A which, however, do not always produce the desirable effect. The authors submit their experience with the surgical alternative of treatment of palmar and axillary hyperhidrosis, i.e. videothoracoscopic upper thoracic sympathectomy. On account of the local form of the disease they implemented four bilateral operations with an excellent effect, another four patients were operated on account of vascular affections of the upper extremities. The authors discuss in detail the indications for and technique of operation, risk and side-effects and above all results based on reports in the literature at home and abroad. From the discussion and experience ensues that upper thoracic sympathectomy can be recommended as a suitable surgical alternative of treatment of severe forms of local hyperhidrosis of the upper extremities and face in particular because of the immediate results, minimal morbidity and long-term effect. The article should make the wider medical and lay public familiar with this not very widely used method.

        Key words: palmar hyperhidrosis - axillary hyperhidrosis - videothoracoscopy - upper thoracic sympathectomy