Definitive treatment of Hyperhidrosis with thoracoendoscopic surgery

Hyperhidrosis is excessive sweating of certain parts of the body. The most recommended treatment is thoracoscopic sympathectomy, a surgery that interrupts the nerves that transmit signals to the sweat glands.

Hyperhidrosis: what is it?

Hyperhidrosis is an excessive sweating of hands, armpits and feet that greatly affects people’s quality of life, especially their social relationships, preventing them from leading a normal life. According to experts in General Surgery, it affects more than 3% of the general population and has a hereditary component. Its origin is not known with certainty but there is an abnormally high stimulation of the sympathetic system at the level of the thorax.

Adverse effects of hyperhidrosis on the patient’s life

Hyperhidrosis causes emotional stress, making the patient’s personal, work and social life difficult, creating a vicious circle due to the need to feel “dry” and the worry of smelling bad. People suffering from Hyperhidrosis become more withdrawn and shy away from social activity, avoiding situations where contact with others is needed, and may even create a social phobia. In addition, the disease makes it difficult to use papers, pencils, buttons, tools, electronic equipment or musical instruments. Finally, it is the need to avoid shaking hands that leads patients to seek a definitive solution.

Diagnosis of Hyperhidrosis

Its diagnosis is clinical and does not require complex or expensive studies. A correct clinical history is advisable to exclude thyroid problems or other associated diseases.
The diagnostic criteria for primary hyperhidrosis are as follows:
1) Local and visible hypersweating, for more than 6 months, with no known secondary cause.
2) At least two of the following characteristics:
o Bilateral and symmetrical
o At least one episode per week
o Interference with usual daily activity
o Onset before the age of 25 years
o Family history
o No sweating during sleep

Hyperhidrosis treatment and innovative techniques

People suffering from Hyperhidrosis or excessive sweating, regardless of temperature and emotional state, which they cannot control, should have surgery, as the disease can also cause fungus, flaking, bad odor, irritation and pigmentation of the skin. Therefore, surgery should be considered in all patients with long-standing hyperhidrosis who have not found improvement with medical treatment.

Currently there are innovative techniques for the treatment of Hyperhidrosis. In the past it was a very aggressive operation and required “opening the chest”. Today, however, thoracoscopic sympathectomy is an operation that is performed using modern minimally invasive surgical techniques. Usually the preparation prior to surgery is simple and requires only a few laboratory tests and consultation with the anesthesiologist, to proceed to schedule the procedure in complete safety.

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With thoracoscopic sympathectomy, the nerves that transmit signals from the sweat glands are interrupted. Thus, the sympathetic chain is located in the posterior part of the thorax and is interrupted by means of an ultrasonic scalpel. Two small 5mm incisions are used, through which a small lens connected to a video camera and some very fine instruments (forceps) designed for this type of operation are introduced.

The operation is performed under general anesthesia and usually requires overnight admission (24h), i.e. the patient goes home the morning after the operation. Patients can return to their normal activities 3-4 days after surgery.

Results of Hyperhidrosis treatment

Thoracoscopic Sympathectomy is the treatment of choice for hypersweating of the hands, with an immediate, permanent and definitive result in more than 95% of patients.

Hyperhidrosis Treatment Risks

Thoracoscopic sympathectomy has almost no risks of consideration. The most frequent adverse effect is compensatory sweating, which consists in an increase of sweating in the thorax, abdomen and thighs, as a mechanism of compensation for the decrease of sweating in hands and armpits (the organism diverts the sweating stimulus to non-intervened areas). This effect has been reported in a significant number of patients and is generally mild and less bothersome than the initial symptoms of hand and armpit sweating. However, it can be severe in 8% of cases. Therefore, the patient should be well informed, analyzing the benefits of surgery and warning of the risk of this compensatory sweating.
Another adverse effect described and of rare occurrence is the so-called Horner’s syndrome, whose most evident manifestation is a slight drooping of the upper eyelid of the eye on the affected side, which usually resolves with the passage of time. This complication is very rare and rarely permanent.
Other possible risks are the usual ones when surgery is performed: hemorrhage, infections, pneumothorax, pleural effusion, among others.