Comparative Study between T3 and T4 Thoracoscopic Sympathicotomy in Management of Primary Palmar Hyperhidrosis in Pediatric Age Group.

Introduction: Hyperhidrosis, while not life-threatening, can significantly disrupt daily life. Thoracoscopicsympathetic chain sectioning is the most effective treatment for children with severe cases. However, compensatoryhyperhidrosis (CH) is a common side effect, affecting 50-90% of patients. The optimal level for sympathetic chaininterruption is debated, aiming to minimize damage to afferent fibers that regulate the sudomotor center. Thisstudy 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 patientswith primary palmar hyperhidrosis, treated between April 2020 and April 2022. Participants were randomlyassigned to two equal groups. Exclusion criteria comprised mild hyperhidrosis, successful medical treatment,contraindications for thoracoscopic surgery, and suspected secondary hyperhidrosis. One-year postoperativefollow-up assessed therapeutic success, side effects, over-dry hands, recurrence, and CH. Patient satisfaction wasevaluated using a visual analog scale.Results: The patients’ ages ranged from 5 to 17 years (Mean 11.22 ± 3.31). Symptoms began between ages 4and 12 (Mean 6.74 ± 2.02). The cohort included 17 males (34%) and 33 females (66%). Group B experiencedmore cases of moist hands compared to Group A (16 vs. 2). Over-dry hands were more frequent in Group A (6cases) than in Group B (1 case). Recurrence occurred in one case in Group A and two cases in Group B. CH wassignificantly 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 ahigher incidence of moist hands, reduced CH rates, and improved patient satisfaction.