Hyperhidrosis

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.