Biportal thoracoscopic sympathectomy for palmar hyperhidrosis in adolescents.
OBJECTIVE
Palmar, axillary, and plantar hyperhidrosis is often socially, emotionally, and physically disabling for adolescents. The authors report surgical outcomes in all adolescents treated for palmar hyperhidrosis via bilateral thoracoscopic sympathectomy at the Barrow Neurological Institute by the senior author.


METHODS
A prospectively maintained database of all adolescent patients undergoing bilateral thoracoscopic sympathectomy between 1998 and 2006 (inclusive) was reviewed. Additional follow-up was obtained as needed in clinic or by phone or written questionnaire.


RESULTS
Fifty-four patients (40 females) undergoing bilateral procedures were identified. Their mean age was 15.4 years (range 10-17 years). Average follow-up was 42 weeks (range 0.2-143 weeks). Hyperhidrosis involved the palms alone in 10 patients; the palms and axilla in 6 patients; the palms and plantar surfaces in 17 patients; and the palms, axilla, and plantar surfaces in 21 patients. Palmar hyperhidrosis resolved completely in 98.1% of the patients. Resolution or improvement of symptoms was seen in 96.3% of patients with axillary and 71.1% of those with plantar hyperhidrosis. Hospital stay averaged 0.37 days with 68.5% of patients discharged the day of surgery. One patient experienced brief intraoperative asystole that resolved with medications and had no long-term sequelae. Otherwise, no serious intraoperative complications occurred. No patient required chest tube drainage. The percentage of patients who reported satisfaction and willingness to undergo the procedure again was 98.1%.


CONCLUSIONS
Biportal, bilateral thoracoscopic sympathectomy is an effective and low-morbidity treatment for severe palmar, axillary, and plantar hyperhidrosis.
Wait
Scott D
SD
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. neuropub@chw.edu
Killory
Brendan D
BD
Lekovic
Gregory P
GP
Dickman
Curtis A
CA
D000293:Adolescent; D002648:Child; D004564:Electrocoagulation / Q000295:instrumentation; D005260:Female; D006225:Hand / Q000294:innervation*; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D006945:Hyperhidrosis / Q000235:genetics / Q000601:surgery*; D007431:Intraoperative Complications / Q000209:etiology; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012881:Skin Temperature / Q000502:physiology; D013546:Sweating / Q000502:physiology; D013562:Sympathectomy / Q000295:instrumentation / Q000379:methods*; D020708:Thoracoscopes; D013906:Thoracoscopy / Q000379:methods*