http://www.ingenta.com/isis/searching/Expand/ingenta?pub=infobike://mal/pei/2004/00000008/00000002/art00006

Thoracoscopic Upper Thoracic Sympathectomy for Primary Palmar Hyperhidrosis in Children and Adolescents: A Ten-Year Experience
 
 Pediatric Endosurgery and Innovative Techniques    1 June 2004, vol. 8, no. 2,   pp. 109-112(4) 
 
Vadim Kapuller; Abraham J. Mares; Jacob Mordehai; Oleg Kleiner; Gideon Karplus; Zahavi Cohen
 
Abstract: 
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.
 
Document Type: Research article ISSN: 1092-6410 

DOI (article): 10.1089/1092641041360878 
SICI (online): 1092-6410(20040601)8:2L.109;1- 