Does Sequential Thoracoscopic Sympathectomy Affect the Development of Postoperative Compensatory Sweating in Children?.

Background: The development of compensatory sweating (CS) following thoracoscopic sympathectomy
(TS) for palmar hyperhidrosis (PH) is the major drawback of this procedure. Several techniques were
proposed to minimize the occurrence of CS such as changing the level of sympathectomy or conducting it
sequentially on both sides with an interval between the two procedures. The aim of this study is to
compare sequential T3-T4 TS versus bilateral same-setting T3-T4 TS regarding the development and
severity of postoperative compensatory sweating.
Methods: This comparative study included 38 patients (20 females and 18 males) with primary palmar
hyperhidrosis between March 2020 and March 2023. Patient's ages ranged between 5 and 18 years, and
they were divided into two groups: group I included 23 patients treated with sequential T3-T4 TS; and
group II included 15 patients who underwent bilateral same-setting T3-T4 TS. Both groups were
compared with regard to patient characteristics, operative details, and postoperative outcomes.
Results: There were no significant sex or age distribution differences among both groups. The mean
cumulative operative time was significantly longer in group I (38 versus 27 min). There was no statistically
significant difference in the rate of compensatory sweating between groups I and II (6/23 [26%] vs
5/15 [33%], respectively; p ¼ 0.77). No over-dryness or recurrence occurred in any patient in either group.
Conclusion: Sequential TS does not seem to have superior results when compared to bilateral samesetting
TS regarding the development of compensatory sweating. Conducting bilateral same-setting TS is
both safe and feasible with shorter operative time, hospital stay, and overall cost