Thoracoscopic sympathicotomy for the treatment of intolerable palmar and axillary hyperhidrosis in children is associated with high recurrence rates

Abstract

Primary hyperhidrosis is a dermatologic condition characterized by excessive sweating beyond that needed for physiologic thermoregulation, without an underlying systemic condition. 1 Primary hyperhidrosis usually affects one or more distinct body sites and, therefore, is also referred to as primary focal hyperhidrosis (PFH). 2 PFH has a wide range of reported estimated prevalence, 3-5 with the most widely cited population prevalence estimate of 2.8%. 4 A recent study estimated population prevalence at 1 to 1.6% for patients

Thoracoscopic sympathicotomy in children for the treatment of palmar and axillary primary focal hyperhidrosis: Caution advocated

“…Despite the high recurrence and reoperation rates in our study, overall patient satisfaction was high with a median satisfaction score of 7.5 (interquartile range of 1.75; range 4-9) [6]. Accordingly, Mol et al recently showed high postoperative satisfaction (average score of 9) despite a high rate of compensatory sweating (65%) following thoracoscopic sympathicolysis in children up to and including 14 years of age [10].…”

“…Finally, and most importantly, we recently published our results of bilateral, one-stage, single-port sympathicotomy (BOSS) for the treatment of intolerable palmar and axillary PFH (HDSS of 4) in children up to and including 16 years of age and, in this study, we found a high recurrence (50%) and reoperation rate (35.7%) [6]. Reoperations were associated with placement of additional thoracoscopic ports, intraoperative placement of pleural drains, and prolonged air leak [6].…”

“…'), we think 16 years of age is too young. We advocate great caution when considering sympathetic denervation in children up to and including 16 years of age for the treatment of palmar and axillary PFH [6]. An exception can only be made when PFH strongly interferes with the child's development and preoperative HDSS is 4, classifying PFH as intolerable.…”

“…An exception can only be made when PFH strongly interferes with the child's development and preoperative HDSS is 4, classifying PFH as intolerable. Ideally, surgical treatment of palmar and axillary PFH is postponed to the age of 17 years or older, especially in view of the excellent results of BOSS for the treatment of palmar and axillary PFH in adults [3,6].…”

Minimally Invasive Sympathicotomy for Palmar Hyperhidrosis and Facial Blushing: Current Status and the Hyperhidrosis Expert Center Approach

“…Only patients rating the severity of their PFH as severe (HDSS 3) or intolerable (HDSS 4) qualify for surgery. Due to a higher recurrence rate of PFH in children younger than 17 years of age, an HDSS score of 4 is mandatory before surgery is even considered in children [41].…”