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Over a decade of single-center experience with thoracoscopic sympathicolysis for primary palmar hyperhidrosis: a case
Adam Mol1, Oliver J Muensterer2
1Department of Pediatric Surgery, Kraków, Poland.
Insights
Thoracoscopic sympathicolysis effectively treats primary palmar hyperhidrosis in children, achieving high patient satisfaction. While compensatory sweating is common, severe complications are rare, making it a viable option for pediatric patients.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Dermatology
Background:
- Primary palmar hyperhidrosis is a debilitating condition affecting children.
- Thoracoscopic sympathicolysis offers a surgical treatment option.
Purpose of the Study:
- To evaluate the efficacy and safety of thoracoscopic sympathicolysis in children under 14 years old.
- To analyze outcomes, complications, and patient satisfaction.
Main Methods:
- Retrospective analysis of 102 children undergoing thoracoscopic sympathicolysis from 2005-2017.
- Procedure involved bilateral bipolar fulguration of thoracic ganglia and nerve fiber disruption.
- Demographic, outcome, complication, and satisfaction data were collected.
Main Results:
- 95% of 98 evaluated patients achieved complete palmar dryness.
- High patient satisfaction reported (average rating 9/10), with 99% willing to repeat the procedure.
- Common side effects included compensatory sweating (65%) and gustatory sweating (6%); unilateral ptosis occurred in one patient.
Conclusions:
- Thoracoscopic sympathicolysis in children yields high satisfaction despite common compensatory sweating.
- The procedure is safe for pediatric patients, with rare severe complications.
- This surgical approach is effective for managing palmar hyperhidrosis in pediatric populations.
Background:
Primary palmar hyperhidrosis is a severely debilitating condition that can affect patients of any age. We report our experience with thoracoscopic sympathicolysis in a large cohort of children less than 14 years of age.
Methods:
All children who underwent thoracoscopic sympathicolysis from April 2005 through January 2017 were evaluated retrospectively. The procedure entailed bilateral bipolar fulguration of the second and third thoracic ganglia with transverse disruption of collateral nerve fibers along the third and fourth rib. Demographic information, as well as postoperative outcome, complications, and satisfaction were analyzed.
Results:
Over the 12 year study interval, a total of 102 children underwent thoracoscopic sympathicolysis for palmar hyperhidrosis. Complete follow-up was available for 98 patients (median age 12 [range 5-14] years; 38 boys [39%]). Median follow-up was 4 [range 2-12] years. Complete palmar dryness was achieved in 93 (95%) cases. One patient suffered postoperative unilateral ptosis, 6 reported gustatory sweating, and 65 experienced compensatory sweating. Average postoperative rating on a 1 (lowest) to 10 (highest) rating scale was 9, with 97 (99%) patients saying that they would undergo the procedure again.
Conclusion:
Our technique of thoracoscopic sympathicolysis in children was associated with very high postoperative satisfaction, despite a high rate of compensatory sweating and occasional autonomic gustatory sweating. Other more severe complications in this age group were rare.
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