Thoracoscopic upper thoracic sympathectomy for primary palmar hyperhidrosis in children and adolescents: A ten-year experience

Objective: We present our experience over the past 10 years with thoracoscopic upper thoracic sympathectomy in patients with primary palmar hyperhidrosis. Subjects: We performed 624 thoracoscopic upper thoracic sympathectomies in 312 patients over a period of 10 years. The youngest patient was 5 years old. Results: When questioned, 297 (95.2%) patients were completely satisfied with the operative results. Two (0.64%) patients were moderately satisfied, complaining of excessive dryness of the palms. Thirteen (4.16%) patients were unsatisfied: 8 (2.56%) patients claimed of only minimal improvement, and 5 (1.6%) patients with dry hands regretted undergoing the operation, mainly because of compensatory sweating. Additional comments were made by patients regarding compensatory sweating, the most common side-effect of the operation, as well as on anhydrotic palms (dry hands) which is the ultimate operative goal. Three hundred (96.2%) patients had an uneventful postoperative course and were discharged on postoperative day (POD) 1. Eleven (3.5%) patients had a subsequent residual pneumothorax that required intercostal drainage and were discharged on POD 3 and one (0.3%) patient had bleeding from intercostal vessels that was successfully managed. Conclusion: The thoracoscopic approach to upper thoracic sympathectomy is presently the procedure of choice. Early surgery for severe palmar hyperhidrosis will save a child years of psychological, social, and physical discomfort and there is absolutely no reason to delay surgery until adulthood, as some general surgeons suggest.