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The use of endoscopic sympathetic blockade (ESB) to treat axillary hyperhidrosis (AH) has become more widespread recently. ESB of the T3 and T4 ganglia is more effective, although it results in a higher incidence of compensatory sweating (CS) than ESB of T4 alone. To reduce CS and improve the level of satisfaction and therapeutic success of ESB, we performed T3 ramicotomy in association with T4 ESB.Ninety patients with axillary hyperhidrosis were randomized into 3 groups of 30 patients—group A (T3 and T4 ESB), group B (T4 ESB), and group C (T4 ESB in association with T3 ramicotomy)—and evaluated for CS, therapeutic success and degree of satisfaction 7 days, 6 months, and 1 year after the procedure.CS was observed in 72 patients (80%) and classified as minor in 63 (70%), moderate in 7 (7.8%), and severe in 2 (2.2%). These results were not statistically significant. There was a higher proportion of remission of symptoms and therapeutic success in group B (100%, P=0.008). Forty-seven patients (52.2%) considered themselves very satisfied, 41 (43.3%) satisfied, and only 2 (2.2%) dissatisfied with their surgery.ESB of T4 alone was more effective than ESB of T3 and T4 together and ESB of T4 in association with T3 ramicotomy. No significant difference was found between the techniques in terms of patient satisfaction or the occurrence and degree of CS; however, in group C, CS was more intense in the thighs, whereas in group A it was more intense in other areas.