Highlights
- •What is currently known about this topic?
- •Thoracoscopic bilateral T3 sympathectomy for primary focal palmar hyperhidrosis in children has excellent short-term outcomes. Data on the long-term outcomes of the operation however are missing.
- •What new information is contained in this article?
- •Despite excellent short-term outcomes, compensatory sweating and recurrence of palmar sweating can occur years after the operation, therefore patients should be followed long-term.
Abstract
Background
Thoracoscopic bilateral T3 sympathectomy for primary focal palmar hyperhidrosis in
children has excellent short-term outcomes. However, data in the literature, on the
long-term outcomes of the operation are scarce.
Methods
We conducted a retrospective institutional review of all children and adolescents
undergoing T3 bilateral thoracoscopic sympathectomy for primary focal palmar hyperhidrosis
between June 2013 and October 2020. We composed a quality of life (QoL) questionnaire
evaluating the patient's perception of how much the hyperhidrosis affected their daily
life in multiple domains. The questionnaire was completed before the operation and
at every postoperative follow-up visit.
Results
We operated on 58 patients with a median age of 15 (6–25) years. There were no intraoperative
or postoperative complications, and all patients had immediate complete postoperative
resolution of their palmar hyperhidrosis. Fifty-three patients (91.4%) had long-term
follow-up data available with a median of 2.5 (range 0.1–7.5) years. Two patients
(3.4%) experienced recurrence of their palmar hyperhidrosis. Nine patients (15.5%)
experienced compensatory hyperhidrosis and required occasional medical management
with oral anticholinergics. Two patients reported regretting having undergone the
operation. Overall, the mean QoL score improved remarkably, from 42/100 before the
operation to 92/100 at 1 month, 89/100 at six months to a year, 97/100 between two
and four years, and 80/100 ≥ 5 years after the operation.
Conclusion
Thoracoscopic bilateral T3 sympathectomy has a high success rate for primary palmar
hyperhidrosis in children in the mid- to long-term. Compensatory sweating and recurrence
can occur years after the operation, so long-term follow up is mandatory.
Level of evidence
IV.
Keywords
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References
- Hyperhidrosis: an update on prevalence and severity in the United States.Arch Dermatol Res. 2016; 308: 743-749
- Primary hyperhidrosis in children: a review of therapeutics.Pediatr Dermatol. 2021;
- Management of primary focal hyperhidrosis: an algorithmic approach.J Drugs Dermatol JDD. 2021; 20: 523-528
- Management strategies of palmar hyperhidrosis: challenges and solutions.Clin Cosmet Investig Dermatol. 2019; 12: 733-744
- Thoracoscopic bilateral T3 sympathectomy for primary focal hyperhidrosis in children.J Pediatr Surg. 2017; 52: 313-316
- Validity and reliability of the hyperhidrosis disease severity scale (HDSS)1.J Am Acad Dermatol. 2004; 50: P51
- A comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: recommendations of the Canadian Hyperhidrosis Advisory Committee.Dermatol Surg. 2007; 33: 908-923
- A systematic review and meta-analysis of T2, T3 or T4, to evaluate the best denervation level for palmar hyperhidrosis.Sci Rep. 2017; 7: 129
- Optimal targeting of sympathetic chain levels for treatment of palmar hyperhidrosis: an updated systematic review.Surg Endosc. 2017; 31: 4357-4369
- Evaluation of compensatory hyperhidrosis after sympathectomy: the use of an objective method.Ann Vasc Surg. 2021;
- Quality of life after thoracic sympathectomy for palmar hyperhidrosis: a meta-analysis.Gen Thorac Cardiovasc Surg. 2020; 68: 746-753
- CT-guided thoracic sympathicolysis versus VATS sympathectomy in the therapeutic concept for severe primary palmar Hyperhidrosis.Thorac Cardiovasc Surg. 2021;
- Percutaneous CT–guided sympathicolysis with radiofrequency for the treatment of palmar hyperhidrosis.J Vasc Interv Radiol. 2017; 28: 877-885
Article info
Publication history
Published online: September 24, 2022
Accepted:
September 15,
2022
Received:
August 25,
2022
Identification
Copyright
© 2022 Published by Elsevier Inc.
