Hyperhidrosis & Sympathectomy

What Is Hyperhidrosis?

Individuals affected with a condition called essential hyperhidrosis where abnormal, uncontrollable and excessive sweating of parts of their body occurs for no apparent reason may benefit from a procedure called a high thoracic thoracoscopic sympathectomy or ETS. Our group has the largest experience with this procedure in the Great Northwest having performed well over 200 ETS.

Is Sympathectomy Right for Me?

The ideal candidates for ETS are patients who have abnormal sweating of their hands only, their hands and feet or their hands, feet and armpits (axillae), in that order. Some patients with facial sweating or facial blushing issues may also benefit but with less predictable outcomes. Not every patient with essential hyperhidrosis is a candidate for ETS and every patient needs to be seen first by a physician with experience with this procedure and counseled appropriately.

What Is the Success Rate of Sympathectomy?

For the right patients, the results of ETS for hand sweating are in the 98-100% range of success. For reasons poorly understood, excessive feet sweating when present will improve about 60% of the times with ETS designed to target the hands. Results at the axillary level are less predictable, around 70 to 80%.

What Are Potential Drawbacks of Sympathectomy?

There are some drawbacks in “drying up” the hands. At times, the hands will become so dry, that patients will be required to regularly some form of skin lotion. The most troublesome drawback is a condition called “compensatory sweating” (CS) that may affect, to some degree, up to 80% of patients who undergo ETS. Fortunately, for only 5% of patients, this CS is so severe that they regret having undergone ETS. We are fortunate in the Northwest in that our climate is not as humid, hot and sticky as in other areas of the world. This may explain why we tend to see less CS than what others have reported.

How Is Sympathectomy Done?

ETS is done as an ambulatory procedure in that all patients are expected to go home on the day of surgery. Both sides are operated on the same day through 2 small incisions per side. Recovery is quite rapid and most individuals are able to return to their normal daily activities within 3-4 days after the procedure.

The technique presently utilized involves isolating and clipping the sympathetic nerve or chain high up in each chest cavity with titanium clips that are permanent. The advantage of this novel technique over the more conventional procedures where the nerve is divided or where a short segment of the nerve is resected, is for potential reversibility of ETS by reoperating and removing the clips in the rare situations where a patient would be completely dissatisfied with the results as a result of severe secondary CS. Potentially, if one was to go back early after the first operation (within 3 months) and remove the titanium clips, the nerve function will recover as before ETS.