Abstract
Purpose The aim of this study was to find out the outcome of “thoracoscopic sympathectomy”
(TS) for palmar hyperhidrosis (PH) in children. To our knowledge, this is the largest
experience of TS from the United Kingdom.
Method All patients who underwent TS for PH during the past 21 years were studied retrospectively.
Results A total of 85 procedures were done in 44 children. Ratio of female to male was 4:1.
Median age at operation was 12.8 years. Types of operations performed were as follows:
bilateral T2-T3 sympathectomy in 87% (38/44), bilateral T2-T5 sympathectomy in 9%
(4/44), and right-sided thoracoscopic (left-sided done open) in 1% (0.5/44); operation
was not possible in 3% (1.5/44) of cases. No chest drains were used. Median postoperative
stay was 2 days (range 1 to 5). Median follow-up time was 1.3 years (range 0.2 to
4.7 years). Only problematic patients were followed up for longer. During follow-up,
21% (9/44) developed severe hyperhidrosis of other parts of body. Seven percent (3/44)
of patients developed severe axillary hyperhidrosis (AH) and required T4-T5 sympathectomy
later on at a median age of 14.4 years (range 11 to 16 years). Another 9% (4/44) patients
developed severe plantar hyperhidrosis. Severe hyperhidrosis of the whole body was
seen in 5% (2/44) of the patients. Postoperative complications were seen in 47% (21/44)
of the patients. They were as follows: postoperative pain (needing > 48 hours hospital
stay) in 18% (8/44); transient Horner syndrome in 18% (8/44—right 5, left 3); and
recurrence of PH in 11% (5/44) of cases. In the recurrence group, 7% (3/44) were unilateral
(right 2, left 1) and 5% (2/44) were bilateral. Redo operations were performed in
11% (5/44) of cases. Median time to redo was 2.6 years (range 8 months to 4.2 years).
All three unilateral recurrent patients underwent respective sided redo. In the bilateral
recurrence group (2/44), one patient had bilateral redo (remained dry), whereas the
other patient underwent only right-sided operation (remained dry), as that sided operation
was difficult and so the other side was not tried.
Final Outcomes The final outcomes were recurrence 3.5% (3/85—right 2, left 1) and technically failed
operation 3.5% (3/85—both sides 1, one side 1). Success rate for thoracoscopic sympathetectomy
was 93% (79/85) overall.
Conclusion TS for PH is a safe and feasible operation in children. It is successful in the majority;
however, the procedure is not trouble free.
Keywords
thoracoscopic sympathectomy - palmar hyperhidrosis - child
