Evaluation of Needlescopic Sympathectomy for Management of Primary Palmar Hyperhidrosis in Children and Adolescents

Saad, Ahmed Yahya; Abdel Aziz, Mohamed Ahmed; Gamaan, Ibrahim Ahmed Ismail; Ahmed, Youssef Mohamed

doi:10.21608/aimj.2025.446627

Evaluation of Needlescopic Sympathectomy for Management of Primary Palmar Hyperhidrosis in Children and Adolescents

Document Type : Original Article

Authors

Pediatric Surgery, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt

10.21608/aimj.2025.446627

Abstract

Background: Primary palmar hyperhidrosis (PPH) is a distressing disorder defined by profuse sweating due to sympathetic nervous system overactivity of unidentified etiology. Needlescopic sympathectomy offers a minimally invasive technique for treating PPH in children and adolescents.
Objective: This study assesses the safety, efficacy, and cosmetic outcomes of Needlescopic sympathectomy in pediatric and adolescent patients with PPH.
Methods: A prospective study was conducted on 30 patients diagnosed with PPH at Al-Azhar University Hospitals between August 2023 and August 2024. All patients underwent bilateral Needlescopic sympathectomy at the R3-R4 level. Preoperative and postoperative assessments included intraoperative complications, compensatory sweating, and quality of life (QOL) scores.
Results: The mean patient age was 11.88 ± 1.9 years, with an average symptom onset at 6.33 ± 1.12 years; all of them had impairment of daily activities. The mean operative time was 41.7 ± 5.35 minutes, and hospital stay averaged 1.3 ± 0.4 days. Intraoperative complications included minimal bleeding in five patients (16.6%), surgical emphysema in two patients (6.6%), and Pneumothorax requiring chest tube insertion in four patients (13.3%). Compensatory sweating postoperatively at one month was mild in three patients (10%) and moderate in one patient (3%), and at six months, four patients had mild CS (13%) with no recurrence observed. QOL scores improved significantly, from 73.2 ± 4.8 preoperatively to 24.7 ± 5.4 postoperatively.
Conclusion: Needlescopic sympathectomy is a safe, efficient, and cosmetically favorable procedure for managing PPH in pediatric and adolescent patients, offering significant improvement in quality of life.

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