Surgery to eliminate excessive sweating of the hands,armpits,and face

HYPERHYDROSIS
Sweating is a necessary phenomenon in order to regulate body temperature; one which is stimulated by heat, the performance of physical activity and exercise, and also having to face certain emotional situations.

Hyperhydrosis is defined as an abnormally heightened production of sweat. It can be classified as primary or secondary, the latter being related to illness.

The process of sweating is controlled by the autonomic nervous system. This involuntary nervous system controls a minimum of five million sweat glands throughout the body. In fact, nearly 2/3 of these sweat glands are located on the hands.

The answer to the hyperhydrosis problem can be found within these nerves.
Hyperhydrosis can occur in many different parts of the body. Normally it occurs on the palms of the hands, but it can also occur on facial areas, the soles of the feet, and the armpits.

Hyperhydrosis is not temporary. Many people that suffer from it have had it for a number of years, usually since childhood.

Causes of hyperhydrosis

Its cause is unknown but it is related to a hyperactivity of sympathetic nervous fibers and a heightened peripheral sweat response. It has a tendency to affect several family members, and has an incidence among the young population of between 0.1% and 0.3%.

Excessive sweating due to heightened sweat gland activity can be generalized, or it can be confined to the palms, soles, armpits, and inferior mammalian and groin areas. The skin of the affected areas can present a pink or white-blue appearance. In extreme cases the skin, especially that of the feet, can have fissures, cuts, and scales.

The heightened skin hydration can be a contributing factor in several skin diseases (mycotic or parasitic infections, contact dermatitis).

The cause of localized sweating is unknown; it happens in perfectly normal individuals. Excessive sweating of the palms and soles can also have psychological causes.

Treatment for hyperhydrosis

Science has been trying to solve this problem for a long time. Until now, no medical plan of action had provided completely satisfactory results.

Surgery is the most effective solution. A procedure known as a sympathectomy has been applied for many years for the treatment of hyperhydrosis.

This technique had many problems. The operation was long and often presented a long period of disability, pain, and a high risk of complications.

Recent progress has made painful and complicated sympathectomy a thing of the past. In the last eight years the endoscopic approach has revolutionized sympathectomy. The surgeon only needs to make a small incision in order to insert a 2mm camera and other surgical instruments. With this treatment option hyperhydrosis can be eliminated in a short time, without the need for hospitalization and with excellent results.

Surgical treatment

There is a treatment that offers a complete and definite elimination of the problem (95-98%): a thoracic sympathectomy. This consists of severing the main section of the sympathetic nerve which regulated the production and secretion of sweat. This procedure is done through a minimally invasive surgery, for which two incisions are performed (0.5cm and 1 cm.) on each side of the thorax. Through these, with the aid of a television monitor, the nerve on each side of the spinal column is identified and then interrupted.

Treating the problem surgically, which consists of a partial severing of the sympathetic chain on the posterior portion of each hemithorax, has been performed since the 1920’s. Access to the thorax is required, and up to a few years ago the surgery was not performed very often since it required the opening of the thorax through a thoracotomy. This course of action was considered too aggressive for what was thought of as a benign problem of little clinical valued to the doctor. Videotoracoscopic surgery appeared in 1922 which, just like arthroscopic and laparoscopic surgeries, permits surgical interventions inside the thorax without the need to open it. A Videothoracoscopy permits the introduction of optical and surgical equipment in order to perform various surgical procedures, among them the treatment of choice for hyperhydrosis, the thoracic sympathectomy.
A videoscopic thoracic sympathectomy is a procedure which requires general anesthesia and a selective pulmonary intubation in order to be performed, has a minimal degree of surgical risk, and an average hospital stay of 24 hours.

Once the indicated portion of the sympathetic chain is cut, the disappearance of the hyperhydrosis is immediate in 98% of the cases. The patient’s degree of satisfaction is very high, and long-term results approach a 95% success rate.

As a secondary effect, a thoracic sympathectomy can cause the patient to have dry hands which may require hydration several times a day. Another secondary effect is called a compensating hyperhydrosis, in which there is a slight increase in sweating on the back or thighs, a problem which patients consider a slight annoyance.

The introduction of the 2 mm surgical equipment through the space between the ribs may on occasion produce a thoracic pain during the first few weeks following the surgery. This can be treated with analgesics.

For the treatment of hyperhydrosis the surgeon must divide the sympathetic nerve at the level of the T2 ganglion. Thanks to developments in the field of endoscopic surgery, today the surgeon can use small instruments and cameras which allow him to enter the body through miniature incisions. This procedure presents a minimal amount of discomfort for the patient.

The patient is under general anesthesia for about one hour or the time that the surgery lasts. Many patients can walk two hours after having the procedure.

Normal physical activity can be started immediately and a return to work is possible in one week or less.

Complications and secondary effects

Compensatory sweating is the effect that causes the most discomfort. It is experienced as excessive sweating of the back, the abdomen, the thighs, and the inferior portion of the leg.

This may occur in a minimal percentage of patients and varies from slight to severe. A short time after the surgery, between 3 and 4 days, some patients continue to experience sweating on the palms of the hands. This phenomenon is temporary and disappears spontaneously.

Another secondary effect is a sweating of the senses of taste or smell. This occurs in 2% of the cases and manifests itself as an increase in sweating when the patient eats or smells certain foods.

Risks and possible complications

Complications are not common to this type of surgery. There may be excessive bleeding, infection of the wound, pneumothorax, and Horner’s syndrome.