Experience of thoracoscopic sympathectomy in severe palmar hyperhidrosis

Abstract

An experience of thoracoscopic sympathectomy in the treatment for palmar and axillary hyperhidrosis in children and adolescents is presented. In 10 years, 553 thoracoscopic sympathectomy were performed in 278 paediatric patients. In total 170 females and 108 males aged 5.5–18 years were operated. The thoracoscope with an additional canal was inserted through a single 11-mm trocar in all patients. The procedure consisted in bilateral ablation of T2 and T3 ganglions. In 272 (98%) patients, an immediate complete disappearance of symptoms was achieved. The early postoperative period was uneventful in 265 patients. In 10 patients, postoperative pneumothorax required intercostal drainage, which was removed in 24 hours after the surgery. Three patients had haemorrhage from the intercostal vessels, which did not require haemotransfusion. The main advantages of thoracoscopic approach are the possibility of performing a bilateral procedure in one operation, minimal operational trauma, favourable postoperative course, short hospital stay, excellent cosmetic results and early return to normal, conforming with the age of a child, activities of daily living. The benefits of surgical intervention in the early stages of the disease is emphasized, which allows the child avoiding significant physiological, psychological and social discomfort.