Endoscopic thoracic sympathetic block by clipping for palmar and axillary hyperhidrosis in children and adolescents

Endoscopic thoracic sympathectomy or sympathicotomy is a safe and effective method of treating primary hyperhidrosis (PH), but postoperative compensat ory sweating may be a problem. There are few reports of sympathetic blockad e by clipping for PH. We present our experience of endoscopic thoracic symp athetic block (ETSB) by clipping in treating palmar (PAH) and axillary hype rhidrosis (AH) in children and adolescents. Between May 1997 and June 1998, a total of 78 patients with PAH or AH underwent ETSB by clipping using an 8-mm, 0 degrees thoracoscope. There were 33 males and 45 females with a mea n age of 14.1 years (range 9-16 y). All patients were placed in a semi-sitt ing position under single-lumen intubation anesthesia; 52 patients with PAH underwent T2 sympathetic block by clipping at the 2nd and 3rd rib beds, an d T3 and T4 sympathetic block was performed at the 3rd, 4th and 5th rib bed s in 26 patients with AH. A total of 156 sympathetic blocks by clipping wer e achieved. The operation was usually accomplished within 20 min (range 16- 30 min). Most patients were discharged within 4 h after the operation. Ther e were neither surgical complications nor mortality. The mean postoperative follow-up period was 32.7 months (range 26-40). Improvement of PAH or AH c ould be obtained in all cases; 70 patients (85.4%) developed compensatory s weating of the trunk and lower limbs. One patient with PAH underwent a reve rse operation with improvement of the sweating 14 days after removal of the endo-clips. ETSB by clipping is thus a safe and effective method for treat ing PH in children and adolescents; compensatory sweating may be improved a fter a reverse operation with removal of the endo-clip.