Palmar Hyperhidrosis In Children Research Articles

Fifteen Years' Experience of Thoracoscopic Sympathetic Chain Interruption for Palmar Hyperhidrosis in Children and Adolescents: Evaluation of Different Techniques.

Background: Thoracoscopic sympathetic chain interruption is a definitive and effective therapy for severe primary palmar hyperhidrosis (PPH). Well-known methods include sympathectomy, sympathotomy, and clipping, but the occurrence of compensatory sweating offsets these methods. This study aims to report our experience with thoracoscopic sympathetic chain interruption in a large group of patients of age <18 years with PPH, focusing on surgical outcomes, complication rates, and patient satisfaction. Patients and Methods: This retrospective study included patients who underwent thoracoscopic sympathectomy, sympathotomy, or clipping for severe PPH between April 2008 and March 2023 at the Pediatric Surgery Department, Al-Azhar University Hospitals. Demographic and clinical data, operative steps, postoperative outcomes, complications, and patient satisfaction were reviewed from the patients' medical records. Results: During the 15-year study period, 420 children with PPH underwent bilateral thoracoscopic sympathetic chain interruption by either sympathectomy, sympathotomy, or clipping, with a sex ratio of 60% being females. The mean ages were 12 ± 3.48, 13 ± 2.45, and 13 ± 2.45 years, respectively. Sympathectomy was performed in 190 patients (45.2%), sympathotomy in 170 patients (40.5%), and clipping in 60 patients (14.3%). All patients had completed follow-up, with mean periods of ∼43 ± 5 months, 45 ± 3 months, and 42 ± 6 months, respectively. Complete palmar dryness was achieved in 405 patients (overall 96.4%) (97.8% after sympathectomy, 97.05% after sympathotomy, and 90% after clipping), whereas 2.1%, 2.9%, and 10% of patients experienced symptom recurrence, respectively, denoting significant statistical differences. Overall, 94 patients (22.4%) experienced compensatory sweating. Eventually, 409 patients (97.4%) were satisfied with the outcome, whereas 11 patients (2.6%) reported dissatisfaction, yet no significant differences found. Conclusion: The presented three modalities of thoracoscopic sympathetic chain interruption for PPH in children and adolescents are safe and effective, with overall very high postoperative satisfaction, despite a relatively high rate of compensatory sweating in sympathectomy group. Other major complications in this age population were scanty.

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

BackgroundThoracoscopic 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. MethodsWe 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. ResultsWe 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. ConclusionThoracoscopic 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 evidenceIV.

Thoracoscopic Sympathectomy versus Thoracoscopic Sympathotomy for The Treatment of Primary Palmar Hyperhidrosis in Children and Adolescents

Thoracoscopic Sympathectomy versus Thoracoscopic Sympathotomy for The Treatment of Primary Palmar Hyperhidrosis in Children and Adolescents

Thoracoscopic T2-T3 versus T4 sympathectomy for primary palmar hyperhidrosis in children and adolescents: a randomized comparative study

BackgroundControversy exists regarding the appropriate level of sympathectomy for primary palmar hyperhidrosis (PH) as different levels are associated with variable postoperative patients’ satisfaction and potential complications. The aim of this study was to investigate the safety, efficacy, and outcome of T2-T3 thoracoscopic sympathectomy (TS) versus T4 TS in this age group.ResultsThis prospective study included 32 patients (17 males and 15 females) with primary PH treated at the department of pediatric surgery, in our institution during the period from February 2019 to February 2020. Inclusion criteria included moderate and/or severe degrees of PH not responding to conservative measures. The patients were divided randomly into two groups: group I treated by T2-T3 TS and group II underwent only T4 TS. All patients were evaluated regarding operative details and postoperative outcome. Follow-up ranged from 6 to 24 months. Group I included 18 patients (14 operated on both sides and 4 operated on one side), and group II included 14 patients (11 operated on both sides and 3 operated on one side). The ages ranged between 5 and 18 years (mean 14.25 ± 3.14 years). The difference in mean age among both groups (14.5 versus 13.9 years) was not statistically significant. The mean operative time was significantly longer in group I (22.4 versus 17.2 min, p value 0.046). The hospital stay (1 day) was similar for both groups. Postoperative compensatory hyperhidrosis (CH) was more frequent in group I (n=7, 50% versus n=5, 45.5%), but the difference was not statistically significant. Postoperative over dryness occurred in 5 patients in group I (28.6%) and temporary Horner’s syndrome in one patient (7.14%). No over dryness or Horner’s syndrome occurred in any patient in group II. The QOL score has improved in both groups; the degree of improvements was better in group II.ConclusionBoth T2-T3 TS and T4 TS are effective in treating primary palmar hyperhidrosis in children and adolescents. T4 TS is preferred than T2-3 TS due to less frequent postoperative complications and better patients’ satisfaction.

TREATMENT OF PRIMARY PALMAR HYPERHIDROSIS WITH VIDEO-ASSISTED THORACOSCOPIC SYMPATHECTOMY IN CHILDREN: EFFECTIVENESS AND PATIENT SATISFACTION

TYPE: Abstract Publication TOPIC: Pediatrics PURPOSE: Hyperhidrosis is an embarrassing condition. We evaluated the effectiveness of video-assisted thoracoscopic sympathectomy to relieve symptoms in children with primary palmar hyperhidrosis and assessed patient satisfaction with the procedure. METHODS: After ethical approval, 30 children (228 females, 93%%) treated with bilateral thoracoscopic sympathectomy for primary palmar hyperhidrosis at a tertiary care hospital from May 2007 to June 2017 were evaluated. Median age at the time of surgery was 12 years (min 5; max 16 years). Using two 5-mm trocars, the sympathetic T3/T4 ganglia were sectioned bilaterally and resected. A hyperhidrosis-related questionnaire was administered to all children after the surgery to assess their satisfaction. RESULTS: Two children with persistent hyperhidrosis required reoperation, which was again performed using video-assisted thoracoscopy. Complete resolution of palmar hyperhidrosis was achieved in 22 (82%) children aAt a median follow- up of 60 months (min 7; max 118 months), 22 (82%) children had achieved complete resolution of palmar hyperhidrosis. In five (18%), symptoms were reduced, but bilateral palmar hyperhidrosis persisted. Postoperative compensatory hyperhidrosis occurred in 55.6%, but was regarded as not important. In relation to satisfaction, all children were very satisfied with the final result of surgery. All stated that they would have done it again, and that they would recommend the procedure for others with primary palmar hyperhidrosis. CONCLUSIONS: Video-assisted thoracoscopic sympathectomy at T3-T4 ganglia was effective to relieve symptoms with high levels of patient satisfaction. The compensatory hyperhidrosis observed in most children did not alter the perception of improvement in symptoms. CLINICAL IMPLICATIONS: Palmar Hyperhidrosis in children. DISCLOSURE: No significant relationships. KEYWORDS: hyperhidrosis, thoracic sympathectomy, patient satisfaction

Thoracoscopic Sympathectomy for Palmar Hyperhidrosis in Children: 21 Years of Experience at a Tertiary Care Center

The aim of this study was to find out the outcome of "thoracoscopic sympathectomy" (TS) for palmar hyperhidrosis (PH) in children. To our knowledge, this is the largest experience of TS from the United Kingdom. All patients who underwent TS for PH during the past 21 years were studied retrospectively. A total of 85 procedures were done in 44 children. Ratio of female to male was 4:1. Median age at operation was 12.8 years. Types of operations performed were as follows: bilateral T2-T3 sympathectomy in 87% (38/44), bilateral T2-T5 sympathectomy in 9% (4/44), and right-sided thoracoscopic (left-sided done open) in 1% (0.5/44); operation was not possible in 3% (1.5/44) of cases. No chest drains were used. Median postoperative stay was 2 days (range 1 to 5). Median follow-up time was 1.3 years (range 0.2 to 4.7 years). Only problematic patients were followed up for longer. During follow-up, 21% (9/44) developed severe hyperhidrosis of other parts of body. Seven percent (3/44) of patients developed severe axillary hyperhidrosis (AH) and required T4-T5 sympathectomy later on at a median age of 14.4 years (range 11 to 16 years). Another 9% (4/44) patients developed severe plantar hyperhidrosis. Severe hyperhidrosis of the whole body was seen in 5% (2/44) of the patients. Postoperative complications were seen in 47% (21/44) of the patients. They were as follows: postoperative pain (needing > 48 hours hospital stay) in 18% (8/44); transient Horner syndrome in 18% (8/44-right 5, left 3); and recurrence of PH in 11% (5/44) of cases. In the recurrence group, 7% (3/44) were unilateral (right 2, left 1) and 5% (2/44) were bilateral. Redo operations were performed in 11% (5/44) of cases. Median time to redo was 2.6 years (range 8 months to 4.2 years). All three unilateral recurrent patients underwent respective sided redo. In the bilateral recurrence group (2/44), one patient had bilateral redo (remained dry), whereas the other patient underwent only right-sided operation (remained dry), as that sided operation was difficult and so the other side was not tried. FINAL OUTCOMES: The final outcomes were recurrence 3.5% (3/85-right 2, left 1) and technically failed operation 3.5% (3/85-both sides 1, one side 1). Success rate for thoracoscopic sympathetectomy was 93% (79/85) overall. TS for PH is a safe and feasible operation in children. It is successful in the majority; however, the procedure is not trouble free.

Palmar Hyperhidrosis: Long‐term Follow‐up of Nine Children and Adolescents Treated with Botulinum Toxin Type A

Primary palmar hyperhidrosis in children and adolescents may be severe enough to affect school and physical activities, causing emotional problems, stress in the patient's life, and a compromised quality of life. Nine patients with palmar hyperhidrosis underwent treatment with botulinum A. Before the session, and in the 1-, 3-, 6-, 9-, and 12-month post-session follow-ups, the patients were administered the Minor test, gravimetry, the Scales of Frequency and Severity, and the Questionnaire of Quality of Life. The mean age was 11 years, with seven girls and two boys. Each patient was administered at least one treatment of botulinum toxin in the palm of the hands (75-150 U for palm), with the mean number of sessions 2.2 (range: 1-4). All sessions in the patients resulted in drying of the hands, with a mean duration of effect of 7 months. Botulinum toxin A controls excessive sweat in the palms of children and adolescents who have primary palmar hyperhidrosis, with an improvement in the quality of life. The therapy is safe and effective in this pediatric group and can be considered before surgical interventions.

Postoperative satisfaction with thoracoscopic sympathectomy for primary palmar hyperhidrosis in children

Postoperative satisfaction with thoracoscopic sympathectomy for primary palmar hyperhidrosis in children

Thoracoscopic Upper Thoracic Sympathectomy for Primary Palmar Hyperhidrosis in Children and Adolescents: A Ten-Year Experience

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.

Transthoracic endoscopic sympathectomy for palmar hyperhidrosis in children and adolescents: analysis of 350 cases.

Primary palmar hyperhidrosis (PH) often commences in childhood and adolescence and can be a disabling condition. There are few reports regarding endoscopic sympathectomy for PH in children and adolescents. Therefore, I present our experience with transthoracic endoscopic sympathectomy (TES) in treating PH in children and adolescents. From July 1994 to March 1998, a total of 350 patients underwent TES. There were 93 males and 257 females with a mean age of 12.9 years (range 5-17 years). All patients were placed in a half-sitting position under single-lumen intubated anesthesia. We performed ablation of the T2 ganglion using either a 6- or an 8-mm 0 degree thoracoscope (Karl Storz Company, Germany) via one 0.8-cm incision just below each axilla. Among these 350 patients, 699 sympathectomies were performed. Usually, TES was accomplished within 15 minutes (range 7-20 minutes). The surgical complications were minimal: one pneumothorax and one segmental lung collapse. There were no surgical deaths. With a mean postoperative follow-up period of 25 months (range 5-44 months), the result of TES was highly satisfactory in 331 patients (94.6%), although 301 patients (86%) developed compensatory sweating of the trunk and lower limbs, the distribution being the axillae (12%), back (86%), abdomen (48%), or lower limbs (78%). The recurrence rates of palmar hyperhidrosis were 0.6% in the first year, 1.1% in the second year, and 1.7% in the third year. Transthoracic endoscopic sympathectomy is a safe and effective method for treating PH in children and adolescents.

Transthoracic endoscopic sympathectomy for primary palmar hyperhidrosis in children: H.-J. Chen, T.-Y. Shih, and M.-H. Cheng. Pediatr Surg Int 11:119–122, (February), 1996

Transthoracic endoscopic sympathectomy for primary palmar hyperhidrosis in children: H.-J. Chen, T.-Y. Shih, and M.-H. Cheng. Pediatr Surg Int 11:119–122, (February), 1996

Transthoracic endoscopic sympathectomy for primary palmar hyperhidrosis in children

Primary palmar hyperhidrosis often starts in childhood. It usually causes academic and social disabling at the age children begin primary school. This study included 65 children (44 girls and 21 boys, mean age 13.5 years) who underwent one-stage bilateral transthoracic endoscopic sympathectomy. The proper sympathetic segment was visualized in almost all cases and electrocautery ablation was performed. The immediate postoperative course was uneventful in all cases and no major morbidity was encountered. Horner's syndrome did not occur in any case. All patients were discharged the day of surgery or after an overnight stay. The duration of follow-up was from 6 months to 3 years. Although compensatory sweating was found in 40% of the patients, long-term satisfaction was reported in 63 cases (96%). This procedure is effective, simple, and is recommended as the method of choice for surgical treatment of severe upper extremity hyperhidrosis in children.

Kao, M. C., et al. Palmar hyperhidrosis in children

Kao, M. C., et al. Palmar hyperhidrosis in children

Thoracoscopic upper thoracic sympathectomy for primary palmar hyperhidrosis in children and adolescents

After 20 years of experience with the “open” transaxillary approach, the authors are presently performing the thoracoscopic technique for upper thoracic sympathectomy in severe primary hyperhidrosis. During a period of 14 months, 23 operations were performed and 22 patients had immediate and permanent relief of palmar sweating. The immediate postoperative course was uneventful in all cases. Hospitalization was short, and all patients returned to school and full activity 3 to 5 days after operation. These initial results compare favorably to the “open” method and, pending further experience, are actually better in terms of less pain, early discharge, quicker return to normal activity, and a smaller, less conspicuous scar.

Palmar hyperhidrosis in children: Treatment with video endoscopic laser sympathectomy

Palmar hyperhidrosis (PH) often starts in childhood and can be a disabling condition for a significant number of young children at the age they begin primary school. There are few reports regarding the surgical treatment of PH in children. The authors report on 40 PH patients under 16 years of age treated with video thoracoscopic laser sympathectomy; there has been substantial experience with this procedure for the treatment of adults with PH. A satisfactory result, with very low morbidity, was achieved for all 40 children. The surgical technique is described briefly. With the technique, the proper sympathetic segment is visualized in almost all cases and then definitely ablated with a fiberoptic low-power laser while under the aid of sympathetic monitoring. Consequently, an adequate sympathectomy warranting a long-lasting therapeutic effect can be achieved without the need of tissue diagnosis. No case required conversion to open sympathectomy. Neither injury to the lung nor bleeding was encountered. Horner's syndrome did not occur in any case. Bilateral sympathectomy was accomplished generally within 30 minutes. All patients were discharged after an overnight stay and are doing well with normal activities. The most frequent complication was compensatory hyperhidrosis, which was tolerable after reassurance. Based on the accumulated experience, it is justified to recommend early surgery, with this refine technique, in cases of severe PH in children.

Transaxillary upper thoracic sympathectomy for primary palmar hyperhidrosis in children and adolescents

Primary palmar hyperhidresis is part of a triad of palmar, plantar, and axillary hyperhidrosis of unknown etiology, affecting children, adolescents, and young adults. Sixty-seven children and young adolescents were operated on during a 10-year period. A total of 103 transaxillary upper thoracic sympathectomies (36 bilateral) were performed, with no mortality. The immediate postoperative course was uneventful in 90%; the other 10% had mostly minor problems. The average hospitalization period was 3 to 4 days. Total abolition of palmar sweating was achieved in all but two patients in whom some residual moisture remained. Long-term extreme satisfaction was reported by 64 of 67 patients (94%). One was moderately satisfied, and two were not satisfied because of excessive “compensatory” sweating elsewhere. Compensatory sweating of some degree was reported by 45% of patients but did not alter satisfaction. By further limiting ganglionectomy to just one ganglion (T2 or T3), compensatory sweating possibly may be reduced further. Early surgery for severe palmar hyperhidrosis will save a child many years of agony and social discomfort because all types of conservative therapy are ineffective and cause unnecessary delay. A limited transaxillary upper thoracic sympathectomy is presently the authors' preffered approach, although ablation via thoracoscopy should not be excluded as further experience is gained with this modality.

Trans-axillary transpleural sympathectomy for Palmar hyperhidrosis in children--a 3 to 7 year follow-up of 9 cases.

Primary palmar hyperhidrosis can be a most unpleasant and distressing affliction. When normal daily activities, viz. writing, schoolwork, are interfered with and other treatments have failed, surgery is indicated. Between 1983-1987 9 children (6 F, 3 M), mean age 10.2 years (range 5-14 years) underwent bilateral transaxillary sympathectomy, 4 simultaneous and 5 1-4 weeks apart. On 14 sides a standard excision of dorsal ganglia (DG) 2, 3, and 4 was performed. The technique of lateral displacement of the sympathetic chain after transection distal to DG 4 and division of preganglionic fibres of DG 4, 3 and 2 was used on 5 sides. In addition to clinical evaluation a pilocarpine stimulation test was performed on the palms of the hands before and at follow-up 3-7 years after surgery. 17/18 hands appeared sympathectomised at early follow-up. One inadequate result required reoperation. Other complications included 2 Horner's syndromes--1 transient and 1 mild but permanent; 3 temporary intercostobrachial paraesthesias, 2 mild late recurrences of sweating and 2 compensatory increases in sweating. In 14 palms where sweat volume was measured before and 3-7 years after surgery there was a mean decrease in sweat of 84% (mg), those sweating the most prior to surgery having the best response. In 2 further palms insufficient sweat was obtained for testing. All but 1 considered the procedure worthwhile. Transaxillary transpleural sympathectomy is a safe, effective, and cosmetically acceptable operation to control symptoms of excessive palmar sweating.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term results of limited thoracic sympathectomy for palmar hyperhidrosis

Eighteen children (15 females, 3 males) aged 7 to 15 years underwent resection of the thoracic sympathetic chain for severe palmar hyperhidrosis. A localized section of chain immediately below the first thoracic ganglion and including the second thoracic sympathetic ganglion was removed. Patients were followed for 24 to 136 months. All patients had immediate and permanent abolition of palmar hyperhidrosis. There was no mortality, one patient developed intermittent ptosis and myosis, three patients reported compensatory hyperhirodsis and one girl was unhappy with the cosmetic results. We conclude that thoracic sympathectomy is a safe and permanent treatment for severe palmar hyperhidrosis in children. In addition, limited sympathetic resection is associated with a lower incidence of compensatory hyperhidrosis than conventional more radical sympathectomy.

Transaxillary sympathectomy for primary hyperhidrosis palmaris in children

Although primary palmar hyperhidrosis is uncommon in the paediatric age group, it is unpleasant and disturbing for the affected child. Both local and medical treatment often fail and only sympathetic denervation can be permanently effective. We have performed seven bilateral transaxillary preganglionic dorsal sympathectomies removing T2, T3 and T4 ganglia. More recently, the surgical technique has been changed to a preganglionic sympathectomy of T4, T3 and T2 with lateral displacement of the sympathetic chain. Four children presented from birth with excessive palmar sweating. The average age at sympathectomy was 9 years. No serious complications were encountered, but one patient developed a mild Horner syndrome, where a composite first and second dorsal ganglia was encountered at surgery, and another child had localised, compensatory, thermally induced hyperhidrosis. Pilocarpine sweat tests before and after surgery showed an 80% reduction in sweat production on stimulation, which correlated well with clinical improvement. The transaxillary approach has certain advantages since it allows for excellent exposure of the sympathetic chain, adequate denervation and minimal morbidity as well as being cosmetically acceptable. It is recommended that transaxillary sympathectomy be performed for primary palmar hyperhidrosis in children after medical treatment has failed.