Excessive Sweating, Endoscopic Transthoracic Sympathotomy
Surgery
At one time surgery for hyperhidrosis was a major operation,
requiring large incisions in the chest or back and separating
ribs to reach the spinal column where the sympathetic nerves
are located. Patients typically stayed in the hospital a week
and could expect to spend a month recovering.
Advances in technology now allow the surgery to be performed
thorascopically, using a procedure that requires just three small
incisions (usually less than half an inch) for a tiny fiberoptic
camera and small surgical instruments to be inserted during the
procedure.
The Operation
Surgery is done using general anesthesia. Two or three small
incisions are made below the armpit. Through these holes, a tiny
telescope is passed which is attached to a miniature video camera.
This allows the surgeon to locate the nerves that stimulate the
sweat glands. Through the remaining one or two incisions, instruments
are placed to allow the surgeon to cut the nerves that affect
the areas where the patient experiences excessive sweating.
For this surgery, the patient's lung must be collapsed to
allow adequate space for the surgeon to maneuver. Following completion
of the operation, the lung is re-expanded and the incisions are
closed. Occasionally a small tube is left inside the chest to
allow release of trapped air; however, this is usually removed
within hours of the surgery.
After one side is completed, the surgeon then works on the
opposite side and an identical procedure is performed.
Typically, a patient remains in the hospital for 12 to 24
hours following surgery. Postoperative pain may result from surgery,
and most patients require some pain medication for 7-10 days.
Risks of Surgery
For most people, the benefits of the procedure far outweigh the
risks. But there are cases in which the surgery should not be
performed. People with severe heart and/or respiratory disease,
a currently active infection, or a low heart rate should not
have the procedure done. In addition, people who have already
had chest surgery or pleurisy of chest trauma generally are not
good candidates.
Compensatory hyperhidrosis is the most common side effect
following surgery. While patients may no longer sweat excessively
in their hands, underarms and/or feet, they often notice they
sweat more in another part of the body, such as the chest, back
or legs. This happens in up to half of patients who have the
procedure — sometimes temporarily, sometimes permanently.
Gustatory sweating (increased sweating when eating) occurs
in approximately 5-10 percent of patients, but is rarely severe.
Horner's syndrome results from inadvertent damage to nerves
above those that were cut. This results in decreased facial sweating,
drooping of the eyelid and a small pupil on the same side of
the body where the nerves were inadvertently injured. This syndrome
is very rare, occurring in less than 1 percent of cases, and
unlikely to happen when an experienced surgeon performs the procedure.
Sometimes these symptoms are reversible over a period of weeks
to months, but they may also prove to be permanent.
*These statements have not been
evaluated by the FDA, and are not meant to diagnose, cure or
treat any disease.
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Excessive
Sweating, Hyperhidrosis Information Source - For Excessive Sweating
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