Management of Bilateral Palmer Hyperhidrosis by Two Stages versus One Stage Thoracoscopic Sympathectomy in Children and Adolescents

Background: Thoracoscopic sympathectomy (TS) is a minimally invasive procedure that interrupts the signal transmission from the sympathetic ganglia to the sweat glands. A surgery that ensures a complete and permanent remission of palmar hyperhidrosis (PH). Objective: The point of this study was to look at the differences between the two types of sympathectomy for PH: One-stage operation for both sides and two stages, one for each side. Methods: Forty kids and teens with PH took part in this prospective randomised comparative study. They were divided into two divided groups: Group I got TS on one side and group II got TS on both sides at the same time. Results: The surgery took less time in the two-stage unilateral TS group compared to the one-stage bilateral TS group (P<0.001), while the total hospital stay was longer in the two-stage unilateral group. There was no significant difference between the two groups regarding intra- and post-operative complications. There were no big differences between the two groups in terms of cosmetic effects, patient happiness, or the state of the hands after surgery. Conclusions: Both unliteral staged and bilateral single stage TS offer safe and effective treatment option for palmer hyperhidrosis. Regarding postoperative compensatory sweating seems to be more common in bilateral single stage but it was in mild form, self-limited and patients didn’t regret the surgery. All patients didn’t complain of dry hand nor Horner syndrome supporting our view of adopting T4 as optimum level for interruption in palmer hyperhidrosis.