Transthoracic endoscopic sympathectomy for palmar and axillary hyperhidrosis in children and adolescents.

Abstract

Primary hyperhidrosis (PH) often starts in childhood and adolescence and can be a troublesome condition. In Taiwan, there is a high incidence in childhood (1.6%-2.0%) and adolescence (2.2%-2.6%). There are few reports regarding transthoracic endoscopic sympathectomy (TES) for PH in children and adolescents. From July 1994 to April 1998, a total of 438 patients underwent TES. There were 174 males and 264 females with a mean age of 14.2 years (range 5-17 years). All patients were placed in a semi-sitting position under single-lumen intubation anesthesia. We performed ablation of the T2 ganglion and any Kuntz fibers in 350 patients with palmar hyperhidrosis and a similar procedure on the T2 and T3 ganglia in 88 patients with palmar and axillary hyperhidrosis using either a 6- or 8-mm thoracoscope via one 0.8-cm incision just below each axilla. In the 438 patients, 875 sympathectomies were performed. There was 1 technical failure due to severe pleural adhesions. TES was usually accomplished within 15 min (range 7-20 min). All except 5 patients were discharged within 4 h after operation. The surgical complication rate was minimal: 1 pneumothorax (0.23%) and 2 segmental lung collapses (0.46%). There was no surgical mortality. The mean postoperative follow-up period was 25.2 months (range 4-45 months). The result was highly satisfactory in 408 patients (93.2%), although 377 (86%) developed compensatory sweating of the trunk and lower limbs, the distribution affecting the back (86%), abdomen (48%), lower limbs (78%), and soles (1.4%). The recurrence rate of palmar hyperhidrosis was 0.6% in the 1st, 1.1% in the 2nd, and 1.7% in the 3rd year. TES is thus a safe and effective method for treating palmar and axillary hyperhidrosis in children and adolescents.