BOB Ped Surg 2023 - Ismael Elhalaby, PAPSA - Presentation

Hello, my name is Dr. Ismail Halabi. I'm from University in Egypt. Today I'll be presenting our study, a randomized comparative study regarding the thoroscopic T2 and T3 symphothectomy versus T4 symphothectomy for primary palmar hyperhydrosis in children and adolescent. Uh, it's well known that hyperhydrosis an excessive respiration beyond the physiological needs and when it's present in significant amounts in the palms and it can cause significant psychological, social and occupational inconvenience. Uh, regarding the the level of symphothectomy, there has always been a controversy regarding the proper level and it was found that both T2, T3 and T4 symphothectomy, all of them they can produce resolution of the palmer symptoms over the different post-operative results, the patient satisfaction. From here we aimed to do this study to compare the safety and the ficacy of T2 and T3 versus T4 in the management of primary palmer hyperhydrosis in children and adolescence. And the study include 32 patients which were randomized into two groups. The first group included 18 patients and second 14 patients. We tended to do the operation sequentially where we operate on one side first on the dominant hand and then we operate on the other hand a few months later on. Uh, group one included uh the 18 patients as we said, 14 of them underwent bilateral uh symphothectomy and four of them underwent unilateral uh only on one side and the group here included 14 patients, 11 of them underwent bilateral symphothectomy and only three underwent uh symphothectomy on one side. Age distribution was comparable on both groups. It ranged from five years up to 18 years of old. Uh almost equal equal also uh sex distribution. Patients were asked initially to rate their quality of life uh with the living with hyperhydrosis ranging from one to five where one is very poor and five is excellent. And as you can see here in the results, the majority of patients mentioned that they are having very poor quality of life living with hyperhydrosis. Uh, we tended to do the surgical technique uh or the surgical procedure in a semi-flower position where the patient were uh had his uh back elevated, tended to the other side. Uh, we had the placed the pores at the fifth intercostal space midry line and for the camera and the working port was in the fourth uh mid uh intercostal space anteriorry line. Uh, out of the uh 32 patients as we have mentioned previously, seven of them had underwent the procedure only on one side because five of them were satisfied with the primary surgery, they went very eager to go uh having the procedure on the other side and two patients lost follow up after three months. No compensation sweating was noticed in any of these patients. Uh, from this uh statistics we can find that uh the operative time was almost was almost comparable in both groups. Uh both of operations were feasible and safe and there was no interruptive complica. Uh regarding the post-operative outcome, post-operative dryness, over dryness was noticed in uh five patients in the group one and it wasn't noticed in any of the patients in group two, compensation sweating uh was present slightly higher in group one. Honor syndrome occurred temporarily in group one, one patient. Uh, again patients were asked to rate the quality of life after the operation in their follow up visits and there was a dramatic change in their uh quality of life uh score where 25 patients rated to have excellent quality of life, five patients rated very good and two patients lost very uh follow up after three months. Then a second questionnaire was taken by the patient three months post-operatively, as you can see here where uh in comparison to the pre-operative evaluation according to to a questionnaire that we have made. Uh uh you can see the difference in the in the results where none of the patients rated good in group one and then 12 patients post operative rated uh rated their quality of life to be good according to a questionnaire. Also in group two, uh all the patients uh scored for good uh 13 patients mentioned scored for good uh unlike the uh scores that they have been scoring before the operation. So we would like to summarize that both T2, T3 and T4 symphothectomy, they are safe and effective treatments. Uh however, post-operative compensatory hyperhydrosis seems to be more common with the T2, T3 symphothectomy compared to the bilateral T4. Uh although we didn't have statistical difference between the two two between the three groups. And also the uh compensatory hyperhydrosis wasn't evident in any of the patients who underwent unilateral symphothectomy. However, this number is still in small subgroup of patients and needs further study to clarify this data. Uh, hand over dryness occurred in a significant higher proportion in in the patients with group two in the first group group T2 and T3 symphothectomy. Uh, mild the moistness of the hand occurred more commonly in T4 group and this wasn't found in any of the patients who had T2 T3 group. Uh, in the majority of cases uh this was very well tolerated by the patients. Unlike the patients who had uh over dryness where it was a little bit distressing for them. Uh so we would like to conclude that uh due to the proof of efficacy of both approaches and the less frequent post-operative complication and more patient satisfaction, we uh in patients in group two, we recommend T4 symphothectomy to be preferred than T2 and T3'scopic symphothectomy. Uh thank you very much and I would like to thank the team of the Cincinnati Children Medical Hospital uh for their support and for giving us the opportunity to present our study. Thank you very much.