Hyperhidrosis

Hyperhidrosis Surgery

If you have severe hyperhidrosis and other treatments haven't worked, surgery may be an option. Mayo Clinic surgeons are among the most experienced anywhere in surgical treatment for hyperhidrosis. In Mayo Clinic's experience, surgery is generally highly successful in treating palmar (palm) and axillary (underarm) hyperhidrosis, but much less successful in treating plantar (feet) hyperhidrosis. Surgery is not advised if only the feet are affected.

Types of surgery

There are three main surgical approaches — two of them with very similar names:

• Sympathectomy has been offered for more than 70 years and involves clipping or removing part of the sympathetic nerve.
• Sympathotomy is a new procedure developed at Mayo Clinic that interrupts the nerve signals without removing the sympathetic nerve. A side benefit is a greatly reduced risk of compensatory sweating.
• Local excision, where targeted sweat glands are removed.

Minimally invasive sympathectomy
In minimally invasive sympathectomy the surgeon places 5 millimeter (mm) clips on the sympathetic nerve to block nerve impulses. For most patients, this treatment is effective at reducing hyperhidrosis symptoms. Performed by experienced surgeons, the procedure stops excessive palmar sweating, less so for the underarms and feet. Rarely, compensatory sweating can occur as a side effect. If this sweating is severe, the procedure can be reversed by removing the clips.

Minimally invasive sympathectomy is offered at Mayo Clinic in Arizona.

The traditional form of sympathectomy, still performed by many surgeons, involves removing most or all of the upper thoracic sympathetic nerve chain. This procedure, also called a ganglionectomy, is not reversible. A common complication of this surgery, which occurs in 5 to 20 percent of cases, is compensatory sweating in which patients experience new excessive sweating elsewhere. For example, the surgery may cure sweating in the palms, but new excessive sweating appears on their groin and/or legs. For some patients, compensatory sweating is as problematic as the original symptoms. For this reason, traditional sympathectomy is not recommended at Mayo Clinic.

Minimally invasive sympathotomy
Endoscopic transthoracic sympathotomy is a relatively new procedure developed and pioneered at Mayo Clinic to control hyperhidrosis without causing compensatory sweating. It has been offered at Mayo Clinic in Minnesota since 1998.

In a sympathotomy, the surgeon disconnects two clusters of nerve cells (ganglions) on the sympathetic nerve by the second rib, blocking the nerve pathway that causes excessive sweating. More than 120 patents have undergone this surgery with excellent results. All patients had complete relief of palmar hyperhidrosis and some improvement in plantar hyperhidrosis. Two patients experienced a form of severe compensatory hyperhidrosis, but only during exercise or working in a heated environment. To date, no postoperative sympathotomy cases of severe compensatory hyperhidrosis have occurred at average room temperatures.

Local excision
In this surgery for axillary hyperhidrosis, surgeons remove targeted sweat glands. The procedure requires small incisions and can be performed with local anesthesia. Most patients report significant, permanent reduction in sweating.

Scars sometimes form following surgery, restricting shoulder motion. The glands may also be removed using liposuction, which results in very little scarring.

The Surgery Process

You'll receive general anesthesia. Then, the surgeon makes two or three small incisions below the armpit, usually less than one-half inch each. A tiny fiber optic camera is gently inserted to allow the surgeon to visualize the targeted nerves that stimulate the sweat glands. Small surgical instruments are inserted through the other incisions to complete the procedure, which is performed by thoracic surgeons or neurosurgeons.

During surgery, your lungs are collapsed to allow adequate space for the surgeon to maneuver. After one side is completed, the surgeon then works on the opposite side, and an identical procedure is performed. Following completion of the procedure, the lung is re-expanded, and the incisions are closed. Typically, you'll be in the hospital for 12 to 24 hours following surgery.

The probability of improved symptoms post-surgery varies with the location of the symptoms.

Risks of Surgery

If you have severe heart and/or respiratory disease, an active infection, or a low heart rate, surgery for hyperhidrosis isn't advised. In addition, if you've had chest surgery or pleurisy or chest trauma, the surgery isn't recommended.

In the past, compensatory hyperhidrosis was the most common side effect of surgery. In essence, patients traded problematic sweating in one area for another. Newer procedures — sympathectomy using clips and sympathotomy — reduce the risk of this side effect.

Gustatory sweating (increased sweating when eating) occurs in approximately 5 to 10 percent of surgery patients, but is rarely severe.

Horner's syndrome results from damage to an adjacent nerve that can occur during surgery. This results in decreased facial sweating, drooping of the eyelid, and a smaller pupil in the eye on the side of the body where the nerves were injured. Horner's syndrome is rare, occurring in less than 1 percent of cases, and unlikely to occur when an experienced surgeon performs the procedure. Sometimes these symptoms are reversible over a period of weeks to months, but they may be permanent.