Background: Hyperhidrosis can be defined as a condition of excessive sweating beyond the body's needs to maintain its temperature within an adequate range. Treatment for primary palmar and axillary hyperhidrosis and facial blushing depends on sympathetic denervation of the affected area which is usually the region innervated by sympathetic ganglia T2, T3, and T4. This can be achieved by sectioning of the sympathetic chain using scissors, electric scalpel, ultrasonic scalpel, or clipping of the chain. Aim of the work:To compare the efficacy between thoracoscopic sympathectomy using metal clips and thoracoscopic sympathectomy using electrocautery as a treatment for primary hyperhidrosis in children to relieve the excessive sweating and improve the patient`s quality of life. Material and Methods: A randomized comparative study on 40 patients suffering from primary hyperhidrosis These patients were allocated randomly into 2 groups. Group (A) was treated by thoracoscopic sympathectomy using clipping technique and group (B) was treated by thoracoscopic sympathectomy using electrocautery technique. Data was tabled and analyzed. Result: A total of 40 patients were enrolled. Success rate among the clipping group was (19/20) 95% and among the electrocautery group was (17/20) 85%, p value was 0.292, compensatory sweating was developed in 11 patients of the clipping group (55%) most of them was of mild to moderate degree and in 11 patients of the electrocautery group (55%) most of them was of mild to moderate degree, p value 0.367. We reversed the procedure in one of our clipping technique patients and showed improvement of the degree of the compensatory hyperhidrosis. Conclusion: Thoracoscopic sympathectomy has been shown to be the most effective treatment for primary hyperhidrosis. Our results showed that clipping technique was as effective as electrocautery technique. Unfortunately, not only the success rates were equal but also the rates of compensatory sweating were found to be similar. The clipping technique offered the advantage of potential reversibility of the procedure in case of severe compensatory hyperhidrosis developed.