Hyperhidrosis is a debilitating condition that affects nearly one percent of the population. It is characterized by excessive sweating that can be socially embarrassing, career restricting, and, in some cases, may even be disabling. Patients with hyperhidrosis suffer from excessive sweating that commonly involves one or several parts of the body, including the hands, feet, axillae (underarms), or, less often, the face. It can be triggered by exercise, stress, and/or embarrassment, but most commonly it is completely without obvious triggers.
Hyperhidrosis most commonly presents itself as extreme—even dripping—wetness of the hands, rendering the patient too uncomfortable to shake hands, making paperwork and writing difficult, and often leading to uncomfortable skin conditions.
Thoracoscopic Sympathectomy for Hyperhidrosis
Primary palmar hyperhydrosis is a pathological condition of overperspiration caused by excessive secretion of the sweat glands, the etiology of which is unknown. This disorder affects a small but significant proportion of the young population all over the world.
Hyperhidrosis is often a debilitating condition in which patients suffer from the social stigmata associated with excessive hand and underarm sweating. The cause of the sweating is believed to be over stimulation of the sympathetic nerve which supplies the offending sweat glands. Patients will often be advised that little can be done for the condition that they must endure. However, a minimally invasive thoracoscopic approach allows for division of the nerves and relief from this disorder.
Causes of Hyperhidrosis
The cause of hyperhidrosis is not well understood, but it is known that the sympathetic nervous system (responsible for the fight-or-flight response when under stress) is important in the control of sweating. This system may for some reason be overactive in patients who suffer from hyperhidrosis.
Non-surgical Treatments for Hyperhidrosis
There are a number of non-surgical treatments for hyperhidrosis, including, but not limited to:
- prescription-strength topical antiperspirants
- orally administered anticholinergic medications, which may partially block the transmission of nerve impulses that have become problematic
- iontophoresis, which uses water and a very mild electrical current to microscopically thicken the outer layer of the skin
However, these treatments are successful in only a small fraction of patients, and none are without side effects. Botox injections often are successful, but they provide only short-term relief, are very costly, and may become less effective over time.
How long do I have to be in hospital?
Although it is possible to have this operation as a day case, in most cases you will be kept in overnight after the operation. Occasionally, if the lung takes a bit of time to expand, you may have to stay in a bit longer. Rarely, a small drain (plastic tube) is needed to help the lung expand.
How successful is thoracoscopic sympathectomy?
This operation usually gives a satisfactory reduction in sweating in over 90% and stops facial flushing in up to 98% of patients. In nearly all cases the results are permanent. Sometimes the palms are so dry after the operation that moisturising cream is needed to prevent cracking of the skin. The operation dries up the hands and sometimes the armpits and may result in extra sweating elsewhere in your body. This "compensatory" sweating commonly occurs on the back below the shoulder blade.
Are there any special complications of thoracoscopic sympathectomy?
Pain: Sometimes the ribs where the telescope was inserted into the chest are sore for a few weeks and hurt on breathing in deeply or coughing. This is due to bruising of the ribs and gradually improves. Taking nurofen can help.
Neuralgia: Nerves near the ribs can be damaged and cause numbness or pain. This usually gets better.
Horner's Syndrome: The only particular complication is a drooping of the eyelid on the side of the operation due to damage of the nerves in the root of the neck. This is rare with thoracoscopic sympathectomy (less than 1 in 50) and usually recovers.
Thoracotomy: Very rarely, there is bleeding in the chest and a large cut has to be made in the chest to stop the blood loss. Very rarely the lungs fail to inflate properly and people need a cut in the chest to stick the lung back up (pleura-adhesis).
Treatment failure: In about 20% of people TECS may not work if you have sweaty armpits. If this happens then Mr Braithwaite may be able to treat you with BOTOX.
It is important that if you have any problems after a thoracoscopic sympathectomy you should contact Mr Braithwaite to discuss the problem. Some doctors do not understand the technique and may give inappropriate advice.
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