BOB Ped Surg 2023 - Ismael Elhalaby, PAPSA - Presentation

Hyperhidrosis is excessive perspiration beyond physiological needs that can cause significant psychological, social and occupational inconvenience when present in significant amounts in the palms

Both T2, T3 and T4 sympathectomy can produce resolution of palmar symptoms but have different post-operative results and patient satisfaction

The study included 32 patients randomized into two groups: group one with 18 patients (14 bilateral, 4 unilateral) and group two with 14 patients (11 bilateral, 3 unilateral)

Operations were performed sequentially, operating on the dominant hand first and then the other hand a few months later

Age distribution ranged from 5 years to 18 years old and was comparable between both groups

The majority of patients rated their pre-operative quality of life as very poor (score of 1 on a 1-5 scale)

The surgical technique used a semi-Fowler position with camera port at fifth intercostal space mid-axillary line and working port at fourth intercostal space anterior axillary line

Seven of 32 patients underwent the procedure on only one side: five were satisfied with primary surgery and did not want the other side done, and two patients were lost to follow-up after three months

No compensatory sweating was noticed in any of the seven patients who had unilateral sympathectomy only

Operative time was comparable in both groups and both operations were feasible and safe with no intraoperative complications

Post-operative hand over-dryness was noticed in five patients in group one (T2/T3) and was not noticed in any patients in group two (T4)

Compensatory sweating was present at slightly higher rates in group one (T2/T3) compared to group two (T4)

Horner syndrome occurred temporarily in one patient in group one (T2/T3)

Post-operatively, 25 patients rated their quality of life as excellent, five patients rated it as very good, and two patients were lost to follow-up after three months

In group one (T2/T3), none of the patients rated their pre-operative quality of life as good, but 12 patients post-operatively rated their quality of life as good

In group two (T4), all 13 patients scored their post-operative quality of life as good, unlike their pre-operative scores

Both T2/T3 and T4 sympathectomy are safe and effective treatments for primary palmar hyperhidrosis

Post-operative compensatory hyperhidrosis seems to be more common with T2/T3 sympathectomy compared to bilateral T4, although there was no statistical difference between the groups

Compensatory hyperhidrosis was not evident in any of the patients who underwent unilateral sympathectomy, but this is a small subgroup that needs further study

Hand over-dryness occurred in a significantly higher proportion in the T2/T3 sympathectomy group (group one)

Mild moistness of the hand occurred more commonly in the T4 group and was not found in any patients in the T2/T3 group

Mild hand moistness in the T4 group was very well tolerated by the majority of patients, unlike hand over-dryness in the T2/T3 group which was distressing for patients

T4 sympathectomy is recommended to be preferred over T2/T3 thoracoscopic sympathectomy due to proven efficacy of both approaches but less frequent post-operative complications and more patient satisfaction in the T4 group