Thoracoscopic upper thoracic sympathectomy for primary palmar hyperhidrosis - The combined paediatric, adolescents and adult experience

Objective: To present our experience, over the past 4 years, of thoracoscopic upper thoracic sympathectomy in patients with primary palmar hyperhidrosis. Design: Retrospective study. Setting: University hospital, Israel. Subjects: 402 thoracoscopic upper thoracic sympathectomies in 223 patients over a period of 4 years. Interventions: Thoracoscopic ablation of ganglia and severing of the sympathetic chain at the level of T2 and T3. 142 patients underwent bilateral simultaneous sympathectomy, 37 had bilateral non-simultaneous sympathectomy and 44 had unilateral sympathectomy. Results: 220 patients (98.7%) had an uneventful postoperative course and were discharged the following day. Three patients with residual pneumothorax required intercostal drainage and were discharged on the third postoperative day. 219 patients (98.2%) were completely satisfied, having immediate and permanent relief of palmar sweating. Four patients were dissatisfied. Conclusion: The thoracoscopic approach to the upper thoracic sympathectomy is at present the procedure of choice, Early operation for severe palmar hyperhidrosis is indicated to save a child many years of frustration and discomfort.