Hyperhidrosis is a disease characterized by excessive sweating in the hands, armpits, face and feet, negatively affecting human life (daily activities and psycho-social status).
Is it possible to treat hyperhidrosis?
Its treatment is often difficult and various methods are used. This is caused by the overfunctioning of a part of the nervous system called the sympathetic nerve. Thus, treatment options based on damage to the nerves in question by various methods have been developed. These include topical and systemic agents, iontopheresis (galvenotherapy), botox injections, chemicals and radiofrequency, and sympathectomy that can be performed with surgical methods. Iontophoresis is applied by immersing the hands and feet in static electric water for half an hour 3 days a week. Although the most frequently applied method is botox injections applied at 1 cm intervals to areas with excessive sweating, its effect usually lasts around 6 weeks and requires repetitive applications. Disadvantages are that it is expensive, painful and has a short duration of action. In addition, various topical agents (aluminum chloride in ethyl alcohol, glutaraldehyde) can be used and they require repetitive applications. The most definitive and permanent treatment method is surgical nerve blocking.
How is the surgical treatment method applied?
In sympathetic nervous system surgery, cutting or burning the sympathetic nerve, clip-on ETS permanently treats sympathetic disorders. While it was previously performed by making an incision in the chest wall (thoracotomy), nowadays, such surgical procedures can be easily and smoothly performed by experienced surgeons using closed surgery techniques (Endoscopic Thoracic Sympathectomy or clip-on ETS) with the development of video-assisted surgery methods.
Under general anesthesia, it is applied through 2 small incisions of 1-2 cm, one in each armpit. According to the patient’s complaints, the sympathetic nerves at the 2nd and 3rd spine levels are cut. The duration of this intervention performed on both armpits varies between 20 and 40 minutes, depending on the experience of the doctor and the operating room personnel. Noticing that the patient’s hands are dry immediately after the operation is an indication that the result is obtained quickly.
How soon is discharge possible in the postoperative period?
The patient, who came out of the operation with a chest drain, is discharged the next day after the drain is removed, without leaving any visible scar, and immediately returns to his daily life.
What are the problems caused by nerve cutting?
Disruption of sympathetic nerve integrity does not affect any other function of the body and harm the body (temporary or permanent paralysis, loss of sensation, etc.).
What are the positive results of surgical treatment?
Hand sweating passes by 95-100%. Immediately after the operation, hands are warm and dry. Facial flushing completely disappears in 80-85 people out of 100, and facial sweating in 95%. Underarm sweating is eliminated by 85-90% and foot sweating is reduced by 64%. Heart palpitations during excitement are reduced. People’s self-confidence increases. It increases their success in business and social life.
Are there any side effects that may occur due to surgical treatment?
This surgery is an extremely safe method if performed by an experienced surgeon. However, although rare, some side effects may occur.
· Reflex (compensatory) sweating: It is the most common side effect. It is excessive sweating that occurs in other parts of the body (back, around the navel, hips and back of the knees) after sweating of the hands, face, armpits and feet. It is seen in 1% after hand and armpit sweating operation, 3-5% after facial sweating operation, 17-20% after facial redness operation.
Gustatuvar sweating: It can be seen at a rate of 3%. It doesn’t bother the person too much. It is the sweating that occurs on the face or body after the intake of certain foods after the operation (it is seen after the intake of bitter or hot foods).
· Horner’s syndrome: It is not seen in our level of sympathectomy.
· Pneumothorax: Sometimes air in the chest cavity outside the lungs can be seen. This is called a pneumothorax. It mostly goes away on its own. Very rarely, air in the chest cavity may need to be evacuated by inserting a tube between the two ribs.
· Bleeding: In very rare cases, bleeding may occur from the vessels between the ribs or from the vessels next to the sympathetic chain. This can be seen and controlled during the operation.
· Intercostal neuralgia: Sometimes, pain may occur in the arms, back and armpits due to damage to the nerves between the ribs at the entry sites. It passes in about 1-1.5 months. It does not cause much discomfort to the patient.
By preventing the patient from receiving anesthesia (narcosis) a second time in a single session bilaterally (for both hands and armpits)
· Surgery is performed through only 1 entry hole for each side
· The patient exits the surgery without drains.
· You can be discharged on the same day.