TRANS-AXILLARY TRANSPLEURAL SYMPATHECTOMY FOR PALMAR HYPERHIDROSIS INCHILDREN - A 3 TO 7 YEAR FOLLOW-UP OF 9 CASES

Primary palmar hyperhidrosis can be a most unpleasant and distressing affliction. When normal daily activities, viz. writing, schoolwork, ar e interfered with and other treatments have failed, surgery is indicat ed. Between 1983-1987 9 children (6 F, 3 M) mean age 10.2 years (range 5-14 years) underwent bilateral transaxillary sympathectomy, 4 simult aneous and 5 1-4 weeks apart. On 14 sides a standard excision of dorsa l ganglia (DG) 2, 3, and 4 was performed. The technique of lateral dis placement of the sympathetic chain after transection distal to DG 4 an d division of preganglionic fibres of DG 4, 3 and 2 was used on 5 side s. In addition to clinical evaluation a pilocarpine stimulation test w as performed on the palms of the hands before and at follow-up 3-7 yea rs after surgery. 17/18 hands appeared sympathectomised at early follo w-up. One inadequate result required reoperation. Other complications included 2 Horner's syndromes - 1 transient and 1 mild but permanent; 3 temporary intercostobrachial paraesthesias, 2 mild late recurrences of sweating and 2 compensatory increases in sweating. In 14 palms wher e sweat volume was measured before and 3-7 years after surgery there w as a mean decrease in sweat of 84 % (mg), those sweating the most prio r to surgery having the best response. In 2 further palms insufficient sweat was obtained for testing. All but 1 considered the procedure wo rthwhile. Transaxillary transpleural sympathectomy is a safe, effectiv e, and cosmetically acceptable operation to control symptoms of excess ive palmar sweating. Preganglionic division of DG 2, 3 and 4 with late ral displacement of the chain appears an equally effective technique a nd theoretically avoids the danger of post-operative Horner's syndrome .