Hyperhidrosis Surgery (ETS)

Hyperhidrosis Surgery (ETS)

In the United States today, our culture places a high standard on good personal hygiene. What exactly do you consider to be "good hygiene"? Clean hands? Well groomed hair? Nice teeth? Daily bathing? A standard of hygiene, like any other value system, is a cultural and socioeconomic phenomenon that varies widely in any given society. In the United States we are uniquely able to strongly reinforce these standards via our media. Advertising presents us daily with the message of what is good and what is not acceptable in a light airy fashion accompanied by song and bright images. One clear message has been that to sweat is unclean, messy and unacceptable outside of hard exercise and labor. "Never let them see you sweat" is a slogan for a popular antiperspirant. Yet another ad campaign heightens our fears of ever raising our arms and showing a sweat stain in the armpit.

For some people, neither the message of "no sweat equals clean," nor the various products we promote to control sweat are helpful. Perspiration is profuse and unchanging for these individuals. It is not due to neglect, lack of caring or bad product choice. It is a physiological condition called hyperhidrosis that is caused by an overactive sympathetic nervous system. For such a person, the simple act of writing a letter is almost impossible because of sweat that drips from the hands onto paper. The anticipation of shaking another person's hand produces anxiety and, unfortunately, even more sweat production that destroys the confidence this gesture should symbolize. Social and business interactions become a nightmare. Dating, for fear of rejection, is avoided.

If you know someone who lives with this condition or if you experience this type of dysfunctional sweating yourself, you should be aware of a surgical solution with a high success rate. At Temple University Hospital, a minimally invasive surgical procedure known as Endoscopic Transthoracic Sympathectomy (Thoracoscopic Sympathectomy) is performed to alleviate hyperhidrosis. The procedure results in modification of the level of sweat production primarily in the hands and the axillae.

Indications/Contraindications:

Mild sweating from the hands, axillae and feet is normal and does not warrant surgery. Furthermore, other causes of increased sweating such as hyperthyroidism should be considered. The patient who has primary hyperhidrosis has usually tried all possible treatment options and seen several physicians for this problem. Unfortunately, in most cases of severe hyperhydrosis, nothing helps very much. These patients have an exceedingly active sympathetic nervous system and most of them have used a variety of other methods including local anti-sweating medicine and an electrophoretic device to deal with their condition. Transthoracic sympathectomy is also useful for other conditions besides hyperhidrosis of the hands and feet. These include reflex sympathetic dystrophy (RSD), atherosclerotic and embolic peripheral vascular disease and Raynaud's disease. Previous lung surgery and emphysema are relative contraindications to this procedure but should considered on a case by case basis. Careful and detailed discussions are always undertaken prior to surgery between the surgeon and the patient.

History of the procedure:

It has been known for several decades that removal of the upper thoracic sympathetic chain and ganglia can correct excessive sweating in the hands (hyperhidrosis). However, because of the technical difficulties involved in reaching the sympathetic chain as it runs along the outside of the spinal column within the chest, the operation never became widely used. However, dramatic improvements in endoscopic technology and instrumentation have provided the means for a less invasive approach to this surgery.

The surgery has also been proven useful in many cases for the treatment of excessive blushing of the face and excessive sweating of the soles of the feet. Risks are the same as for any surgical procedure and are minimal in the hands of an experienced surgeon. The results are usually immediate and permanent, with patients thrilled with the experience of warm and dry hands and often feet, for the first time in their lives.

The Surgery:

The procedure is performed in the operating room as an elective surgery and usually involves an overnight stay in the hospital. The patient is admitted through the Short Procedure Unit (SPU), given a standard admission workup and brought into the operating room. General anesthesia is administered through an endotracheal tube. This allows the anesthesiologist to deflate one lung at a time to allow the surgeon to approach the sympathetic chain through the chest. Afterward, a chest tube is left in place for a few hours to evacuate any remaining air (pneumothorax). The patient then is removed from the ventilator, permitted to awaken fully and given a chest x-ray. Once the x-ray is cleared, the chest tubes are removed and the patient can be sent home. The patient has two Band-Aid sized incisions which are hidden by each armpit. The stitches are absorbable, eliminating the need for an extra postoperative office visit. Normal activity can be resumed after a few days.

Results:

The results are usually immediate and a surprise to the patient who finds him/herself dry and warm for the first time in many years. The procedure is almost always successful. If the patient has reported plantar (foot) hyperhidrosis, in two out of three cases this is resolved by the surgery also. Patients report that they feel less anxious in stressful situations. Stage fright is reduced. The results are usually permanent.

The most common side effect of this procedure is known as compensatory hyperhidrosis or increased sweating in other parts of the body, most commonly over the chest and the back of the legs. Some patients report improvement in this condition over time and relate very little trouble with the effect while others do not. Other possible side effects include gustatory hyperhidrosis (facial sweating while eating), Horner's Syndrome, pneumothorax, intercostal neuralgia and nasal obstruction.

Summary:

Primary hyperhidrosis is a condition of excessive sweat production by an overactive sympathetic nervous system. It is socially and personally embarrassing for persons living with this problem. The thoracoscopic sympathectomy is a relatively simple and quick solution for this problem for most patients.

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