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Long-term outcomes of bilateral thoracoscopic T3 sympathectomy for primary focal hyperhidrosis in children

  • Author Footnotes
    1 Present address: General Surgery Resident, Department of Surgery, University Hospitals, Herestraat 49, 3000 Leuven, Belgium.
    Felix R. De Bie
    Correspondence
    Corresponding author.
    Footnotes
    1 Present address: General Surgery Resident, Department of Surgery, University Hospitals, Herestraat 49, 3000 Leuven, Belgium.
    Affiliations
    Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3615 Civic Center Boulevard, Philadelphia, PA 19104, USA
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  • Tameyah Mathis-Perry
    Affiliations
    Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3615 Civic Center Boulevard, Philadelphia, PA 19104, USA
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  • Melanie Zimmerman
    Affiliations
    Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3615 Civic Center Boulevard, Philadelphia, PA 19104, USA
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  • Kali Rhodes
    Affiliations
    Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3615 Civic Center Boulevard, Philadelphia, PA 19104, USA
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  • Pablo Laje
    Affiliations
    Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3615 Civic Center Boulevard, Philadelphia, PA 19104, USA
    Search for articles by this author
  • Author Footnotes
    1 Present address: General Surgery Resident, Department of Surgery, University Hospitals, Herestraat 49, 3000 Leuven, Belgium.
Published:September 24, 2022DOI:https://doi.org/10.1016/j.jpedsurg.2022.09.014

      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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