Comparative Study between T3 and T4 Thoracoscopic Sympathicotomy in Management of Primary Palmar Hyperhidrosis in Pediatric Age Group. | ||
| Ain Shams Journal of Surgery | ||
| Volume 17, Issue 4, October 2024, Pages 323-328 PDF (327.73 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ASJS.2024.312486.1154 | ||
| Authors | ||
| Mohamed Abd Elmenam Ibrahim Farag; Kamal Abdel-Ellah Aly; Ahmed El Sayed Lotfy; Adham Elsaeid; Hisham Sheir; Tamer Ashraf Wafa* | ||
| Pediatric Surgery Department, Mansoura University, Mansoura, Egypt | ||
| Abstract | ||
| Introduction: Hyperhidrosis, while not life-threatening, can significantly disrupt daily life. Thoracoscopic sympathetic chain sectioning is the most effective treatment for children with severe cases. However, compensatory hyperhidrosis (CH) is a common side effect, affecting 50-90% of patients. The optimal level for sympathetic chain interruption is debated, aiming to minimize damage to afferent fibers that regulate the sudomotor center. This study compares outcomes of sympathicotomy performed at the third versus fourth rib (T3 vs. T4). Patients and methods: This prospective, single-blind, randomized controlled trial included 50 pediatric patients with primary palmar hyperhidrosis, treated between April 2020 and April 2022. Participants were randomly assigned to two equal groups. Exclusion criteria comprised mild hyperhidrosis, successful medical treatment, contraindications for thoracoscopic surgery, and suspected secondary hyperhidrosis. One-year postoperative follow-up assessed therapeutic success, side effects, over-dry hands, recurrence, and CH. Patient satisfaction was evaluated using a visual analog scale. Results: The patients’ ages ranged from 5 to 17 years (Mean 11.22 ± 3.31). Symptoms began between ages 4 and 12 (Mean 6.74 ± 2.02). The cohort included 17 males (34%) and 33 females (66%). Group B experienced more cases of moist hands compared to Group A (16 vs. 2). Over-dry hands were more frequent in Group A (6 cases) than in Group B (1 case). Recurrence occurred in one case in Group A and two cases in Group B. CH was significantly higher in Group A (56% vs. 16%; p = 0.015), with two severe cases in Group A and none in Group B. Conclusion: T4 thoracoscopic sympathicotomy offers comparable success to T3, with the added benefits of a higher incidence of moist hands, reduced CH rates, and improved patient satisfaction. | ||
| Keywords | ||
| Hyperhidrosis; thoracoscopic; sympathectomy; sympathecotomy; compensatory hyperhidrosis | ||
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