Surgical Treatment for Excessive Sweating from Hyperhidrosis

Hyperhidrosis can be effectively treated with surgery, a procedure known as Endoscopic Thoracic Sympathectomy (ETS).  ETS has been shown to reduce increased sweating in the majority of patients.  In one study of 850 patients, 98% of the patients said that the results of the surgery were satisfactory, (1) while another study of 233 patients showed satisfactory results in 95% of patients (2).   In both studies, there were no major adverse outcomes.

Endoscopic Thoracic Sympathectomy (ETS) - How it Works
ETS is a surgical procedure used to control excessive sweating.  Sweat is regulated by the sympathetic nervous system, a specialized group of nerves with a primary purpose of responding to fear.  The sympathetic nervous system also controls about five million sweat glands in the body, and about half of these are located in the hands. 

The signal to produce sweat originates in the brain in an area known as the hypothalamus.  This signal then travelsthrough the thoracic cavity (behind the lungs) one major group of sympathetic nerves to control sweating in the body.  This bundle of nerves is known as the sympathetic chain.  By disrupting this system of nerves, excessive sweating can be decreased. 

Since the sympathetic chain that produces hand, feet and facial sweating is located in the chest, a thoracic or chest surgeon is the medical specialist that performs the surgery.  Historically, chest surgery involved opening the chest through a large incision and was generally thought of as a "major" operation.  Today advancements in chest surgery using small incisions and a scope or camera to see inside the chest make surgery for hyperhidrosis more practical.

The ETS Procedure
Before the surgery starts, the patient is placed under general anesthesia.  Two small incisions, approximately 5 to 10 millimeters in length, are then made in each armpit.  The lungs are gently moved away from the location of the sympathetic chain by placing carbon dioxide in the chest cavity. The lungs function normally during the operation but they are moved slightly away from the operative area to allow the surgeon to work.  The endoscope is inserted in the chest, which includes a fiber-optic camera and a surgical instrument. The sympathetic chain is located on the rib and removed. Once the surgery is completed, the carbon dioxide holding the lungs away from operative area is removed, and the lung is expanded.  The equipment is removed and the incisions are closed, often without sutures.  Documentation of the ganglion (nerves) are made at the time of surgery by the pathology department.

Once the sympathetic chain is disrupted the excessive sweating is gone. The results are immediate.  Most people are ready to recuperate at home after spending a few hours in the hospital recovering from the effects of the anesthesia.  Under most circumstances, a full recovery is made in a few days. 

Side Effects of Sympathectomy for Excessive Sweating
In the study mentioned above, the main side effects included:

• Hemothorax (blood in the thoracic cavity, behind the lungs) in 1% to 2%
• Recurrence of symptoms in 2%

Another common side-effect of endoscopic thoracic sympathectomy is increased sweating in other areas of the body.  This is known as compensatory sweating.  The studies above found compensatory sweating in 55% and 67% of individuals, which was primarily located on the trunk.  However, only 2% stated that this side-effect was as bad as the original hyperhidrosis.