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Thoracoscopic upper thoracic sympathectomy for primary palmar hyperhidrosis--the combined paediatric, adolescents and adult experience.

OBJECTIVE
To present our experience, over the past 4 years, of thoracoscopic upper thoracic sympathectomy in patients with primary palmar hyperhidrosis.


DESIGN
Retrospective study.


SETTING
University hospital, Israel.


SUBJECTS
402 thoracoscopic upper thoracic sympathectomies in 223 patients over a period of 4 years.


INTERVENTIONS
Thoracoscopic ablation of ganglia and severing of the sympathetic chain at the level of T2 and T3. 142 patients underwent bilateral simultaneous sympathectomy, 37 had bilateral non-simultaneous sympathectomy and 44 had unilateral sympathectomy.


RESULTS
220 patients (98.7%) had an uneventful postoperative course and were discharged the following day. Three patients with residual pneumothorax required intercostal drainage and were discharged on the third postoperative day. 219 patients (98.2%) were completely satisfied, having immediate and permanent relief of palmar sweating. Four patients were dissatisfied.


CONCLUSION
The thoracoscopic approach to the upper thoracic sympathectomy is at present the procedure of choice. Early operation for severe palmar hyperhidrosis is indicated to save a child many years of frustration and discomfort.