introduction / background

Primary hyperhidrosis is an underrated problem in children and adolescents. Thoracoscopic sympathectomy (TS) is indicated in severe cases or after failure of non-surgical methods. Controversy exists regarding the appropriate level of sympathectomy as different levels are associated with different outcomes especially in terms of post-operative complications and patients satisfaction.


The aim of this study was to investigate the safety, efficacy, outcome of T2-T3 versus T4 TS in this age group.

Materials & Methods

This prospective study included 32 patients (17 males and 15 females) with palmar hyperhidrosis treated at the department of pediatric surgery, Tanta University during the period from January 2018-February 2020. Inclusion criteria included moderate and or severe degrees of palmer hyperhidrosis not responding to medical measures. Exclusion criteria included any contraindication to thoracoscopy. The patients were divided randomly into two groups. Group I: included 18 patients treated by T2-T3 thoracoscopic sympathectomy (14 operated bilaterally and 4 on one side); and Group II: included 14 patients underwent only T4 thoracoscopic sympathectomy (11 operated bilaterally and 3 on one side).


The ages ranged between 5 and 18 years (mean 14.25 +/- 3.14 years). For T2-T3 group, the mean operative time was longer in group I (22.4 versus 17.2 minutes); the mean length of hospital stay was one day for both groups. Postoperative compensatory hyperhidrosis were more frequent in Group I (n=7) versus Group II (n=5) (50% versus 45.5%). 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 quality of life (QOL) based on a detailed questionnaire has improved in both groups. In group I, the pre-operative QOL was fair (n=7), poor (n=11). The postoperative QOL was fair in 5 patients and good in 12, one patient lost follow up after 3 months. In group II, the pre-operative QOL was fair (n=5), poor (n=9). The postoperative was good in 13, one patient lost follow up after 3 months.


Both techniques (T2-T3 or T4 TS) are effective in treating primary palmar hyperhidrosis in children and adolescents. T4 TS is more preferred than T2-3 TS due to less frequent postoperative complications and more patients’ satisfaction.


1. Cohen Z, Shinar D, Levi I, Mares AJ. Thoracoscopic upper thoracic sympathectomy for primary palmar hyperhidrosis in children and adolescents. J Pediatr Surg. 1995;30(3):471-473. 2. Krasna MJ, Demmy TL, McKenna RJ, Mack MJ. Thoracoscopic sympathectomy: the U.S. experience. Eur J Surg Suppl. 1998;(580):19-21. 3. Pablo Laje , Kali Rhodes, Leanne Magee, Mary Kate Klarich Thoracoscopic bilateral T3 sympathectomy for primary focal hyperhidrosis in children. J Pediatr Surg. 52 (2017) 313–316

acknowledgement / Contact

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