Single port thoracoscopic sympathectomy for primary palmar hyperhidrosis in adolescence

Abstract

IntroductionHyperhidrosis is a health problem having negative effects on adolescent quality of life, affecting daily social activities or educational life. Primary focal hyperhidrosis (PFH) is often observed in axillary, palmar, plantar, and craniofacial regions and more than one region can be involved (1). There is still no consensus about the mechanism of hyperhidrosis in adolescents. The prevalence is reported as 0.6%-1.0% in young populations (2).Thoracoscopic sympathectomy, which is accepted as the gold standard for the permanent cure of PFH, is achieved by interruption of impulse transmission from sympathetic ganglia to the sweat glands (2,3). A few studies reported that surgery should be performed before adulthood, emphasizing that adolescents tolerate side effects better than adults (1,3-7).Among adolescents, primary palmar hyperhidrosis (PPH) is widely disregarded and undertreated. To the best of our knowledge, there is no study reporting PPH treatment with single port video-assisted thoracoscopic sympathectomy (VTS) in adolescents in Turkey. Herein, we report our experience and short-term outcomes of this treatment, where the symptom resolution, intraoperative and postoperative complications, patient satisfaction, and subsequent compensatory sweating (CS) are analyzed. Materials and methodsSeven adolescents who underwent VTS for PPH between March 2011 and July 2012 were included. The indications for operation in our patients were chosen according to the Multi-Specialty Working Group on the Recognition, Diagnosis, and Treatment of Primary Focal Hyperhidrosis criteria: focal, visible, excessive sweating of at least 6 months in duration without an underlying cause, plus at least 2 of the following characteristics: a distribution that is bilateral and relatively symmetric, impairment of daily activities, at least 1 episode per week, onset before 25 years of age, family history of PFH, or focal sweating that ceases during sleep (8).Data were collected retrospectively. The chief complaint of patients was palmar hyperhidrosis. Additional axillary hyperhidrosis was present in 6 patientsAim: Hyperhidrosis is defined as excessive sweating beyond the physiologic needs of a person. Palmar hyperhidrosis in the adolescent period may have an impact on school work and may cause psychological problems. In this study we aim to increase awareness of this disregarded problem. Materials and methods:We explicated the early outcomes of 7 consecutive adolescents, where single port video-assisted thoracoscopic sympathectomy was performed for primary palmar hyperhidrosis. Patients were evaluated for symptom resolution, which was defined as complete dryness, patient satisfaction, operative complications, and compensatory sweating.Results: In total 13 thoracoscopic procedures were done in 7 adolescents, consisting of 4 girls and 3 boys (median age = 16 years). Thoracoscopic sympathectomy achieved immediate complete dryness and all were very satisfied with the outcome of the procedure. Compensatory sweating was defined as mild by 4...

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