Do children tolerate thoracoscopic sympathectomy better than adults?

Palmar hyperhidrosis (PHH) is fairly a common condition, which is treatable by thoracoscopic sympathectomy (TS). Compensatory sweating (CS) is a major side effect of TS. We compared the TS procedure's long-term success, patient's satisfaction and complications between children (≤14 years of age) and adolescents and adults (≥15 years of age). A chart review of the patients who had undergone TS at three medical centers (Hillel Yaffe, Soroka and Bnai-Zion) who could be contacted and agreed to reply to a detailed telephone questionnaire yielded 325 patients with a >24-month follow-up. There were 116 children and 209 adolescents and adults with a follow-up of 2-8 years. Most participants (96.3%) reported complete or reasonable symptomatic relief. The long-term postoperative satisfaction was high (84.5%), and significantly higher among children (92.2%) compared to adolescents and adults (80.7%) (P = 0.005). CS appeared within 6 months postoperatively in 81.8% of all the patients but significantly less in children (69.8%) compared to the others (88.5%; P < 0.001). CS increased with time in 12% of the participants, but decreased in 20.8% of the children versus 10.5% of the others (P = 0.034), usually within the first two postoperative years. The severity of the CS was also lower in children: it was absent or mild in 54.3% of the children versus 38.0% of the others, and moderate or severe in 45.7 versus 62%, respectively (P = 0.004). Fifty-one percent of the participants claimed that their quality of life decreased moderately or severely as a result of CS, but only one-third of them (7.9% children vs. 22.4% others, P = 0.001) would not have undergone the operation in retrospect. Thoracoscopic sympathectomy relieves PHH in most cases. Most patients prefer relief from PHH even at the cost of moderate or severe CS. The rate of CS and its severity is tolerated better by children, and their postoperative satisfaction is higher than that of adolescents and adults. Therefore, unless otherwise contraindicated, we recommend doing TS as early as possibly.