Surgical treatment of excessive sweating


After all non-surgical methods for treating hyperhidrosis have been tried, and yet a satisfactory effect is not achieved, after considering all the pros and cons, you and your doctor can decide to conduct surgical treatment. There are a number of different surgical approaches to treating excessive sweating (hyperhidrosis). With excessive sweating of the armpits, two fundamentally different options are possible: a local effect on the sweating zone and operations on the chest sympathetic trunk, the so-called Endoscopic Thoracic Sympathectomy (ETS). To local methods of influencing the zone of excessive sweating of the armpits (curettage, shaving, ultrasonic curettage, aspiration curettage, liposuction, excision) can be resorted to in the early stages, practically at the patient's will, since these methods are not associated with serious side manifestations and in case of failure are accompanied Only temporary inconvenience and minimal cosmetic defect. To ETS in any variants (sympathectomy, sympathicotomy, ablation, coagulation of gangylins, Ramicotomy, clipping), the ratio should be much more cautious, as adverse events, especially potential compensatory hyperhidrosis, can significantly reduce the patient's quality of life. In a number of countries (practically all European countries, the United States, Taiwan), it is even legally forbidden to conduct ETS for palmar hyperhidrosis before all possible options for conservative treatment are tried (antiperspirants, ionophoresis, botox).


Local surgical methods for treating excessive sweating of the armpits

Local methods (called local because they are performed directly in the area of ​​increased sweating) in various versions - curettage, aspiration curettage, liposuction, shaving, ultrasonic curettage, liposuction, excision) are used to treat excessive sweating of the armpits. The idea of ​​surgery is to reduce the total number of sweat glands, which will lead to a decrease in sweating. Radically cures the problem of sweating of the armpits excising the area of ​​axillary hyperhidrosis. Often, the operation brings good and excellent results, although insufficient interventions are also possible.

Endoscopic Thoracic Sympathectomy

As noted earlier, ETS refers to operations, which can only be resorted to as a last resort, when all possible methods for treating excessive sweating have been exhausted. Mostly, the operation is applied with pronounced increased sweating of the palms and stressful reddening of the face. With excessive sweating of the armpits, ETS is used much less often, and many experts consider this operation unacceptable in the treatment of excessive sweating of the armpits due to potential pronounced side effects in the form of compensatory hyperhidrosis. The essence of the operation consists in interrupting the nerve impulse emanating from the spinal cord and directed towards the sweat glands. This is achieved by crossing, removing, destroying or clipping (clamping with a special titanium clip) a sympathetic trunk located in the chest cavity next to the spine, which ultimately leads to a "shutdown" of the sweat glands.

The operation is performed under anesthesia. Through the punctures in the chest, a miniature video camera is inserted and under its control with special instruments a sympathetic trunk intersects in a special area. The operation is performed on both sides. The operation is technically well developed and basically it is very easy to tolerate by patients who are able to leave the clinic almost in a few hours after the operation. The most important side manifestation of the operation is compensatory hyperhidrosis (sweating of the chest, abdomen, buttocks, thighs), which makes very cautious attitude to the operation.

Effective use of the surgical method in the treatment of excessive sweating of the armpits

Before you consider the possibility of surgical treatment for hyperhidrosis (hyperhidrosis), you and your doctor should be sure that all other methods, including antiperspirants, iontophoresis, iontophoresis with the addition of anticholinergics, Botox injections, and combinations of these methods are exhausted or impossible For some other reason. In addition, the patient and the physician should consider in detail all the pros and cons of surgical treatment, discuss the risks of performing an operation.

Despite the frequent use of ETS (Endoscopic Thoracic Sympathectomy) for the treatment of hyperhidrosis, due to possible risks of adverse events and a decrease in satisfaction with the results of surgery due to adverse events, many doctors argue about the inadvisability of ETS in general. We share this position in the treatment of sweating of the armpits, in which the performance of sympathectomy is not justified. In the treatment of palm sweating, in a specially selected group of patients, in the absence of the effect of conservative therapy, ETS may be the only method of treatment.

Before discussing the possibility of treating sweating surgically, you should discuss with your doctor the possibilities of non-surgical treatment. You should be alerted if the doctor does not discuss this treatment with you and is not interested in whether you conducted it. Remember that surgical methods for treating excessive sweating refer to highly specialized surgical procedures and require a lot of experience for their perfect conduct. Before agreeing to an operation, make sure that the surgeon to whom you applied for this help has sufficient experience in carrying out these operations, is familiar with the latest advances in the treatment of excessive sweating.