Skip to main content
Log in

Do children tolerate thoracoscopic sympathectomy better than adults?

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript


Palmar hyperhidrosis (PHH) is fairly a common condition, which is treatable by thoracoscopic sympathectomy (TS). Compensatory sweating (CS) is a major side effect of TS. We compared the TS procedure’s long-term success, patient’s satisfaction and complications between children (≤14 years of age) and adolescents and adults (≥15 years of age). A chart review of the patients who had undergone TS at three medical centers (Hillel Yaffe, Soroka and Bnai-Zion) who could be contacted and agreed to reply to a detailed telephone questionnaire yielded 325 patients with a >24-month follow-up. There were 116 children and 209 adolescents and adults with a follow-up of 2–8 years. Most participants (96.3%) reported complete or reasonable symptomatic relief. The long-term postoperative satisfaction was high (84.5%), and significantly higher among children (92.2%) compared to adolescents and adults (80.7%) (P = 0.005). CS appeared within 6 months postoperatively in 81.8% of all the patients but significantly less in children (69.8%) compared to the others (88.5%; P < 0.001). CS increased with time in 12% of the participants, but decreased in 20.8% of the children versus 10.5% of the others (P = 0.034), usually within the first two postoperative years. The severity of the CS was also lower in children: it was absent or mild in 54.3% of the children versus 38.0% of the others, and moderate or severe in 45.7 versus 62%, respectively (P = 0.004). Fifty-one percent of the participants claimed that their quality of life decreased moderately or severely as a result of CS, but only one-third of them (7.9% children vs. 22.4% others, P = 0.001) would not have undergone the operation in retrospect. Thoracoscopic sympathectomy relieves PHH in most cases. Most patients prefer relief from PHH even at the cost of moderate or severe CS. The rate of CS and its severity is tolerated better by children, and their postoperative satisfaction is higher than that of adolescents and adults. Therefore, unless otherwise contraindicated, we recommend doing TS as early as possibly

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Steiner Z, Kleiner O, Hershkovitz Y, Mogilner J, Cohen Z (2007) Compensatory sweating following thoracoscopic sympathectomy: an acceptable trade-off. J Pediatr Surg 42:1388–1392

    Article  Google Scholar 

  2. Panhofer P, Zacherl J, Jakesz R, Bischof G, Neumayer C (2006) Improved quality of life after sympathetic block for upper limb hyperhidrosis. Br J Surg 93(5):582–586

    Article  PubMed  CAS  Google Scholar 

  3. Kestenholz PB, Weder W (2002) Thoracic sympathectomy. Curr Probl Dermatol 30:64–76

    Article  PubMed  Google Scholar 

  4. Dumont P, Denoyer A, Robin P (2004) Long-term results of thoracoscopic sympathectomy for hyperhidrosis. Ann Thorac Surg 78:1801–1807

    Article  PubMed  Google Scholar 

  5. Gossot D, Galetta D, Pascal A, Debrosse D, Caliandro R, Girard P, Stern JB, Grunenwald D (2003) Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis. Ann Thorac Surg 75:1075–1079

    Article  PubMed  Google Scholar 

  6. Kao MC, Lin JY, Chen YL, Hsieh CS, Cheng LC, Huang SJ (1996) Minimally invasive surgery: video endoscopic thoracic sympathectomy for palmar hyperhidrosis. Ann Acad Med Singapore 25:673–678

    PubMed  CAS  Google Scholar 

  7. Cohen Z, Levi I, Pinsk I, Mares AJ (1998) Thoracoscopic upper thoracic sympathectomy for primary palmar hyperhidrosis—the combined paediatric, adolescents and adult experience. Eur J Surg Suppl 580:5–8

    Article  PubMed  Google Scholar 

  8. Rex LO, Drott C, Claes G, Göthberg G, Dalman P (1998) The Böras experience of endoscopic thoracic sympathectomy for palmar, axillary, facial hyperhidrosis and facial blushing. Eur J Surg Suppl 580:23–26

    Article  PubMed  Google Scholar 

  9. Chou SH, Kao EL, Lin CC, Chang YT, Huang MF (2006) The importance of classification in sympathetic surgery and a proposed mechanism for compensatory hyperhidrosis: experience with 464 cases. Surg Endosc 20(11):1749–1753 Epub 5 Oct 2006

    Article  PubMed  Google Scholar 

  10. Chiou SM (2005) Chronological changes of postsympathectomy compensatory hyperhidrosis and recurrent sweating in patients with palmar hyperhidrosis. J Neurosurg Spine 2:151–154

    PubMed  Google Scholar 

  11. Herbst F, Plas EG, Fugger R, Fritsch A (1994) Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs. A critical analysis and long-term results of 480 operations. Ann Surg 220:86–90

    Article  PubMed  CAS  Google Scholar 

  12. Lai YT, Yang LH, Chio CC, Chen HH (1997) Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy. Neurosurgery 41:110–115

    Article  PubMed  CAS  Google Scholar 

  13. Friedman B, Zohar E, Shachor D, Bendahan J, Jedeikin R (2000) Video-assisted transthoracic sympathectomy in the treatment of primary hyperhidrosis: friend or foe? Surg Laparosc Endosc Percutan Tech 4:226–229

    Article  Google Scholar 

  14. Lin TS, Wang NP, Huang LC (2001) Pitfalls and complication avoidance associated with transthoracic endoscopic sympathectomy for primary hyperhidrosis (analysis of 2200 cases). Int J Surg Investig 2:377–385

    PubMed  CAS  Google Scholar 

  15. Zacherl J, Huber ER, Imhof M, Plas EG, Herbst F, Függer R (1998) Long-term results of 630 thoracoscopic sympathectomies for primary hyperhidrosis: the Vienna experience. Eur J Surg Suppl 580:43–46

    Article  PubMed  Google Scholar 

  16. Licht PB, Pilegaard HK (2004) Severity of compensatory sweating after thoracoscopic sympathectomy. Ann Thorac Surg 78:427–431

    Article  PubMed  Google Scholar 

  17. Jaffer U, Weedon K, Cameron AE (May 2007) Factors affecting outcome following endoscopic thoracic sympathectomy. Br J Surg 11 [Epub ahead of print]

  18. Dewey TM, Herbert MA, Hill SL, Prince SL, Mack MJ (2006) One-year follow-up after thoracoscopic sympathectomy for hyperhidrosis: outcomes and consequences. Ann Thorac Surg 81(4):1227–1232 discussion 1232–1233

    Article  PubMed  Google Scholar 

  19. Adar R, Kurchin A, Zweig A, Mozes M (1977) Palmar hyperhidrosis and its surgical treatment: a report of 100 cases. Ann Surg 186:34–41

    Article  PubMed  CAS  Google Scholar 

  20. Leseche G, Castier Y, Thabut G, Petit MD, Combes M, Cerceau O, Besnard M (2003) Endoscopic transthoracic sympathectomy for upper limb hyperhidrosis: limited sympathectomy does not reduce postoperative compensatory sweating. J Vasc Surg 37:124–128

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Zvi Steiner.

Additional information

Hillel Yaffe Medical Center and Bnai-Zion Medical Center are affiliated to the Rappaport Faculty of Medicine, The Technion, Haifa, Israel. Soroka Medical Center is affiliated to Ben-Gurion University, Beer-Sheba, Israel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Steiner, Z., Cohen, Z., Kleiner, O. et al. Do children tolerate thoracoscopic sympathectomy better than adults?. Pediatr Surg Int 24, 343–347 (2008).

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: