|
|
|
|
|
|
|
|
|
|
|
Surgery
After all other treatments have been tried, adjusted for individual circumstances,
and still found to be ineffective, surgical treatment for excessive sweating may be an option considered by your physician.
There are a number of different types of surgery that are sometimes used to treat hyperhidrosis.
These include local surgical procedures that remove the sweat glands and endoscopic thoracic
sympathectomy (ETS). ETS, in particular, is considered a last resort because it frequently causes serious,
irreversible compensatory sweating. And in fact, most physicians do not recommend ETS
surgery because of the serious negative side effects of the procedure.
Local Surgical Techniques
The local procedures (termed local because the surgery is performed at the point of the sweating)
excision, curettage, and liposuction may be used to treat extreme underarm sweating. During excision,
sweat glands may be cut out. Similarly, during curettage they may be scraped out. And during liposuction
they may be removed by suction. Dermatologists often have good results with these techniques.
Endoscopic Thoracic Sympathectomy (ETS)
As mentioned above, most experts do not recommend ETS for the treatment of hyperhidrosis. During ETS surgery, physicians
attempt to interrupt the transmission of nerve signals from the spinal
column to the sweat glands and to thus prevent these nerve signals from "turning on" the sweat glands.
The procedure is performed with the patient under general anesthesia. A miniature camera is inserted
into the chest under the armpit. A lung is temporarily collapsed so the surgeons can cut or otherwise destroy
the nerve paths associated with the overactive sweat glands. This procedure is permanent,
and currently there is no reversal technique.
 |
 |
Small incisions are made |
Cutting of the nerve |
After the surgeon completes this procedure on one side of the body, he/she performs the same procedure
on the other side. ETS has been used to treat severely sweaty palms and sometimes the combination of
sweaty palms and sweaty underarms, but it is major surgery and a treatment with significant risks.
Compensatory Sweating
Compensatory sweating is excessive sweating that may occur on the back, chest, abdomen, legs, face,
and buttocks as a side effect of ETS surgery. This side effect is grave because it can be equally or
even more extreme than the original sweating problem.
In a study involving 121 patients at the Medical City Hospital of Dallas, Texas, compensatory sweating
occurred in more than 80% of the patients undergoing ETS. Similarly, in a Danish study conducted at
the Aarhus University Hospital, 90% of the patients undergoing ETS for underarm sweating, reported compensatory
sweating, half of whom were forced to change their clothes during the day because of it.
Using Surgery Effectively
Before considering surgery, patients and their physicians should be confident that they have thoroughly
exhausted all other available treatment options, including prescription strength
antiperspirants, iontophoresis, iontophoresis with
the addition of an anticholinergic, Botox injections,
and combinations of these treatments.
Additionally, patients and their physicians must seriously weigh the pros and cons of surgery, and be informed of the significant risks
of the procedure. There are many physicians who argue that the high risk of complications after ETS surgery, and the relatively low rates
of post-ETS satisfaction as a result of these problems, mean that ETS can rarely, if ever, be used effectively to treat hyperhidrosis.
It is recommended that you talk to a dermatologist before resorting to surgery. A dermatologist may be able to
recommend effective non-surgical options, and may recommend and be able to perform a local surgery as opposed to ETS.
Keep in mind that surgical procedures for the treatment of excessive sweating are considered major surgery and require special training.
If you are considering surgical treatment, be sure your dermatologist (if he or she will be performing
your surgery) or surgeon is well-trained and informed of the most recent research. When considering an operating dermatologist or
surgeon, ask about the percentage of their patients who experience side effects such as compensatory sweating with ETS, and demand to speak to
a variety of patients he/she treated for hyperhidrosis. Since some complications from this surgery become apparent years after the procedure,
you should speak with patients who had the operation at least two years ago. Ask these patients about their satisfaction with this surgery, whether
they are experiencing side effects, and whether they would recommend surgery to others.
Next Steps
Have you talked to your doctor about excessive sweating? If not, now is the time! Learn more about how you and your doctor
can work together to find the right treatment,
or combination of treatments, to manage your hyperhidrosis.
If you’re considering surgery to treat excessive sweating, please know that experts in the field strongly
recommend that you try antiperspirants,
iontophoresis and
Botox injections first. Click on the links provided
to learn more about the usefulness of these treatments. To learn more about the common complications of ETS,
read Internet message boards discussing the procedure and its aftereffects.
And remember, because hyperhidrosis is a serious medical condition, you deserve insurance coverage and
reimbursement for your doctor’s visits and treatments! We’ve got tips to help you navigate the health
insurance realm in our Insurance Tools section.
|
|
|
|
|
|
 |
|
|
 |
|
|
|
|
|
 |
|
|
Find a doctor who treats excessive sweating. |
|
|
 |
|
|
|
|
|
 |
|
|
|
|
|
 |
|
 |
|
|
|
|
|
|
|
|
