Excessive sweating, medically referred to as hyperhidrosis, is a condition that causes sweating so severe, that afflicted individuals often do not engage in activities most take for granted like wearing nice clothes, shaking hands, or even gripping onto objects. This condition, which affects approximately 7.8 million Americans, commonly occurs in young adults, but may develop as early as childhood and persist throughout adult life.
The Mount Sinai Hospital offers a permanent solution to those who suffer from this benign, yet socially devastating disease. This procedure, called bilateral endoscopic transthoracic sympathectomy (ETS), is a highly effective treatment that allows the surgeon to cut the sympathetic nerves at a precise location via two small incisions – one on each side of the chest. The results are typically immediate, as patients notice a dramatic reduction of sweating and a significant improvement in their quality of life.
The symptoms of excessive sweating usually appear at puberty and may stem from a family history of this condition. More than half of the patients afflicted with hyperhidrosis are women, but there is no ethnic or geographic predominance of those with this condition.
Excessive sweating most commonly involves the hands in 25 percent of cases, axilla (armpit) in 20 percent of cases, and both in 55 percent of cases. Plantar (feet) hyperhidrosis also occurs in 45 percent of cases. Sweating can be elicited by emotional or stressful situations.
Etiology of excessive sweating is classified as either a primary or secondary disease. Primary hyperhidrosis is a disorder of unknown cause that may affect up to one percent of the general population. Secondary hyperhidrosis can arise as a consequence of a number of medical conditions such as hypoglycemia, hyperthyroidism, neurological disorders, focal lesions of central nervous system, drug use (antidepressants), and menopause to name a few. Every effort should be made to identify and correct the underlying cause of the hyperhidrosis before beginning treatment.
ETS: Permanent Hyperhidrosis Treatment and Return to Normalcy
Bilateral ETS permanently treats excessive sweating of the hands and axilla (armpit). There are other, more conservative treatments that many patients undergo to treat excessive sweating. These include Botox and Drysol cream, and are most often administered by dermatologists. However, these treatments are not permanent solutions and can be cost prohibitive in upwards of thousands of dollars per year. Furthermore, treatments such as Drysol cream can have unwanted side effects, such as severe drying and cracking of the skin.
ETS is not only permanent, but also very cost effective. In fact, many patients who undergo this procedure have already tried the more conservative treatments, but were not happy with the results.
The procedure is performed under general anesthesia and involves making two small incisions in the armpit. Anesthesia is administered by intubation with double lumen tube intubation for selective, single-lung ventilation. This allows the surgeon to safely approach the sympathetic chain through the chest one lung at a time. Using small instruments, the surgeon inserts a small telescope attached to a camera and a dissection device into the chest cavity and cuts the sympathetic nerve. After completing the sympathectomy on the left and right sides, the two incisions are closed. The postoperative recovery involves some chest and incision site discomfort for two or three days. Most patients return to their daily routines after a week.
In our experience, most patients are very happy with the results of the sympathectomy.
Fouad E. Lajam, MD