Surgical Measures

Sweat Gland Excision

Surgical removal of the subcutaneous tissue (and the sweat glands) in the axillae can eliminate sweating in that area. This type of surgery has been the traditional approach for axillary hyperhidrosis that does not respond well to other therapies. Like all surgeries, there is some risk involved with the procedure. Liposuction of the area may also provide benefits for the patient with less disruption to the surrounding skin, smaller surgical scars and a diminished hairs loss.

In summary this procedure;

• Is an option for the axillae only (not for hands or feet)
• Can be effective, but technique dependent
• Wound healing and scaring may occur
• Recurrence a concern
• Covered by MSP, but difficult to find surgeons who perform this surgery

Sympathectomy:

This procedure involves cutting or removing nerves from within the chest cavity to block the communication with the sweat glands. This surgery permanently interrupts the nerve signal that triggers excessive sweating. It has been used as a permanent, effective treatment for palm and axillae hyperhidrosis since 1920. It should be reserved as the final treatment option.

The targeted nerves, known as the sympathetic chain, lie inside the back of the chest wall beside the spinal column. They can be approached either through an open thorax or via an endoscopic procedure. Once inside the chest, the surgeon will remove, cut, cauterize or clip the nerves and/or nerve bundles. Different surgeons have been trained in the different techniques and all appear to be effective in a high percentage of cases.

Open Thorax Sympathectomy

This procedure is major surgery. The surgeon must make a large incision in the chest, cut through the chest muscles and separate the ribs before he/she can reach the operative area. This procedure requires a long and painful recovery in hospital and is seldom performed today.

Thoracoscopic Sympathectomy

Like open thorax sympathectomy this procedure requires general anesthesia for the patient, but this technique is much less invasive and allows for a quick recovery from surgery.

Once the patient is asleep, the surgeon will make two or three small (5-10mm) incisions below the armpit. The doctor then inserts a small fiber optic television camera into the chest cavity to find the sympathetic chain. Once in position, the surgeon will then use the other incisions to introduce working instruments and use these instruments to operate on the targeted nervous tissue.

To perform this operation, the patient's lung must be collapsed to allow adequate space for the surgeon to operate. Once the procedure is complete, the lung is reinflated and the incisions are closed. Once one side is complete, the surgeon repeats the same procedure on the opposite side.

Usually, the patient will remain in hospital for 12-24 hours after surgery.

Here are some quick facts on this procedure;

• Very effective (greater than 90%)
• Operator dependent
• Can be for axillary and palmar hyperhidrosis
• Not for plantar hyperhidrosis (technically not feasible)

Complications:

• Horner's syndrome (a type of nerve damage) as high as 3.8%
• Hemothorax (blood in the chest) and pneumothorax (free air in the chest) - (0.3% reported)
• Rare cardiac arrest during the operation

Side-effects:

• Compensatory general hyperhidrosis in up to 84% of patients
• Gustatory hyperhidrosis - sweating after eating - (up to 57%)
• Phantom sweating (sensation of sweating but no production of sweat) 48%
• Neuralgia (pain in the sympathectomy affected areas): rare
• Cost: covered by MSP in Canada
• Private pay - can cost thousands