Hyperhidrosis

What is it

It is estimated that approximately 1% of adults suffer from Hyperhidrosis. Hyperhidrosis just means excessive sweating. Perspiration is a normal physiologic response of the body when the internal or body temperature rises, and it is controlled by the autonomic nervous system. In patients with hyperhidrosis, the autonomic stimulation of the sweat glands is hyperactive. The autonomic nervous system increases sweat production by the sweet glands which are present in higher numbers in the skin of the hands, feet, armpits and the genital regions. So patient with hyperhidrosis often has sweaty palms. It is the most common manifestation, and the most socially disturbing. He or she will fears any situation which may require hand contact. This can impact on one's ability to interact effectively in the work place, and can have devastating effects on one's social interaction with the opposite sex.

Endoscopic Thoracic Sympathectomy( ETS )

The goal of surgery is to eliminate the constant autonomic stimulation of the palmar sweat glands while maintaining other sympathetic nerve function, and minimizing trauma to the surrounding tissue. This is best accomplished by Endoscopic Thoracic Sympathectomy, also known as ETS. The procedure is performed with thoracoscopy through two small incisions in the armpit. A portion of the chest sympathetic chain is dissected carefully and then T3/T4 sympathectomy will be performed. 

Results

The relief of severe hand sweating is immediate and permanent.The overall satisfaction rate in patients with severe palmar hyperhidrosis who undergo ETS is greater than 95%.

Side effects 

Compensatory Sweating

Some compensatory sweating after ETS is unavoidable. In patients with hyperhidrosis the propensity to have excessive sweating cannot be eliminated. Surgery only eliminates the pathway to the sweat glands of the hand. But in the majority of these patients, compensatory sweating is mild, well-tolerated and an acceptable alternative to severe palmar sweating.

Horner's Syndrome 

It may occur if the sympathetic nerve near the T1 level is injured. In patients who experience Horners Syndrome, the eyelid appears to droop slightly. The other manifestations such as absent facial sweating, or a sluggish pupil are rarely seen. The frequency of this is less than 1%, and in those who do experience it, it may resolve spontaneously. Careful dissection limited to the T2 level minimizes the risk of developing a droopy eyelid postoperatively.