Hyperhydrosis is a condition of excessive perspiration that occurs in up to 1% of the population.  It can occur in the hands, feet, or underarms.  When severe, patients may literally be able to drip sweat from their hands, and its effects can be devastating, causing enormous social and emotional issues.  It is not simply a case of 'being nervous' but with time, anxiety becomes a major issue.  The condition may run in families and is more common than once thought.  

What are the symptoms?

Patients with hyperhydrosis have excessive sweating that hampers their activities of daily living.  It is sometimes brought on by stress, emotion, or exercise, but can also occur spontaneously.  Patients with palmar hyperhydrosis, have wet, moist hands that sometimes interfere with grasping objects.  Most patients with palmar hyperhydrosis also consider it a difficult social problem since every time they shake hands, they leave the other person's palm very moist, a sensation most people find unpleasant.  Those who suffer from axillary hyperhydrosis sweat profusely from their underarms causing them to stain their clothes shortly after they dress.  Once again, this proves to be very unsightly and a social disadvantage.  Plantar hyperhydrosis is the excessive sweating of the feet ad leads to moist socks and shoes as well as increased foot odor.

What is the treatment for hyperhydrosis?

Treatment includes a variety of methods to limit perspiration.  These include a variety of antiperspirants, as well as electrical stimulation.  In extremely severe cases, dividing the sympathetic nerves in the chest (thoracoscopic sympathectomy) can give excellent results.  

What surgery is performed to treat this condition?

The surgical treatment of hyperhydrosis involves destroying or removing a specific portion of the main sympathetic nerve.  The sympathetic nerve "chain" is formed by  a plexus of nerves located next to the ribs in the chest.  The spine is made up of vertebra, which are blocks of bone stacked one on top of another like building blocks and end in a bundle of cells called a ganglion.  There is a ganglion at each vertebral level of the spine and all these ganglions are attached one to another longitudinally to form the "sympathetic chain".  The surgical therapy entails removing or destroying the specific ganglion that cause sweating in the arm and the axillae.  Typically the patient remains in the hospital for a period of 12-24 hours following surgery and most patients will require some oral pain medication for a period of 7-10 days following surgery.

What are the risks of surgery?

There are certain risks that are common to all forms of surgery.  These include: allergic reaction to anesthetic agents or drugs, infection at the site of operation, older patients are subject to cardiac problems (heart attack, abnormal rhythm), stroke, pneumonia, blood clots, and urinary tract infections.  The incidence of any of the above potential complications is very low (1% or less) but such problems can arise with any form of surgery, and patients must be aware of all the risks no matter how small.

There are some potential side effects of the surgery.  the most common of these is compensatory sweating which occurs in up to 50-60% of patients.  One must remember that sweating is one form of regulating the body's heat.  If the operation prevents sweating in the upper chest, back and arms, it is possible that patients will notice a greater amount of sweating elsewhere in their body in order to compensate for the lack of sweating in the abdomen, back, buttocks, thighs, or feet.  While this appears to be merely a nuisance for most patients, occasionally (5-10% of the time) it can be sever and interfere with the patient's lifestyle.

A second potential side effect is gustatory sweating.  Patients who develop this problem note increased sweating when they are eating.  this occurs in approximately 5-10% of patients but is rarely severe.

Finally, there is a small but real incidence of Horner's syndrome (1%).  this occurs when the highest sympathetic ganglion (the first ganglion or "stellate" ganglion) is damaged during the operation.  When this occurs, the patient notes three findings on the side of the face where the stellate ganglion was injured.  These include a slight droop in the eyelid, a small or narrow pupil, and the lack of sweating on that side of the face.  This syndrome is sometimes reversible over a period of weeks to months, but may also prove to be permanent.  Although the incidence of this is quite low (1%), it is a potential complication of which all patients should be aware.  Overall, the exception of compensatory sweating, the incidence of complications or side effects remains gratifyingly low.

What are the chances of success?

The probability of success varies with the anatomic location of the excessive sweating.  ETS will cure approximately 95-98% of excessive hand (palmar) hyperhydrosis and approximately 75-80% of armpit (axillary) hyperhydrosis.  Approximately 25% of patients with hyperhydrosis of the feet (plantar) will note some improvement, however, the operation is not designed to treat this disorder and should not be used primarily if this is the only complaint.

Summary

Although ETS is overall a safe and highly effective method of treatment for the hyperhydrosis syndrome, it must be realized that it remains a surgical procedure with the inherent risks described above.  As with most disorders, non-invasive medical forms of therapy should be tried prior to surgery.  It is only when these prove to be unsuccessful or impractical for long-term use that a surgical procedure should be contemplated.  Once the decision to pursue surgery is made, patients would best be served looking for a board certified thoracic surgeon experienced in performing video-assisted thoracic surgery (VATS) otherwise known as thoracoscopy.

There are a number of very good websites available for information.  Please remember that many of theses are attempting to sell something and so care in interpreting this information is necessary.

www.handsdry.com