When Excessive Sweating Becomes Torment – Minimally Invasive Surgery to Treat Hyperhidrosis

What is the cause of hyperhidrosis and who is particularly affected by hyperhidrosis?

Many people start sweating their hands when they are stressed, tense or in embarrassing situations. When you work hard physically or you are exposed to great heat you may sweat heavily. This serves physiologically for cooling and is not pathological.

The pathological version is called hyperhidrosis. Hyperhidrosis doesn't mean just sweating a lot. In this case, the cause of the sweating is a malfunction of the vegetative (involuntary) nervous system, which stimulates the sweat glands to an increased extent.

Increased sweating of the armpits (“hyperhidrosis axillaris”) and of the palms of hands (“hyperhidrosis palmaris”), are the most common forms excessive sweating (hyperhidrosis). Primary hyperhidrosis occurs with a frequency of almost 3% in the population and can have a significant impact on daily life, both functionally and socially.

The social impairment that hyperhidrosis can entail is an enormous problem for some of those affected. They often suffer from this problem at an early age, and the suffering often increases in intensity during adolescence and teenage years.

In about 50% of all those affected, the occurrence is genetically determined. Other triggers for extreme sweating of the hands are often of emotional origin. People who quickly become nervous, get angry quickly or are more anxious also often suffer from sweaty hands.

Excessive sweating can be treated with ointments, medications, as well as botox injections. When is an operation recommended?

The German Dermatological Society recommends a step-by-step approach depending on the extent of the disease. In mild cases, treatment with conservative measures such as antiperspirants, iontophoresis (treatment with low-level direct current electricity) and Botox injections can be tried, sometimes concomitantly with drug treatment.

If you sweat profusely or the conservative treatment is not successful, the minimally invasive blockage of the sympathetic nerve in the thorax is a very effective, immediately effective and lastingly successful procedure.

How is the operation performed? What are the risks?

The procedure used today by specialists - the endoscopic sympathetic blockade (ESB4) - uses a camera with a diameter of 5 mm, so that there are practically no scars. The pain level is also negligible.

In contrast to previously used techniques, in which the sympathetic trunk was severed, with this method the sympathetic trunk is blocked with a small titanium clip. The nerve is usually gently exposed above and below the 4th rib head and clamped with a clip.

The patient is positioned in a half-sitting position with arms outstretched and a 5 mm access is made at the level of the 3rd and 5th rib. The procedure can be completed on both sides within 30 minutes without repositioning the patient.

The advantage of this procedure lies in the extremely low frequency of complications and even in the rare event that compensatory sweating occurs, the clip can be removed again.

What are the chances of success of the operation?

The effect of the operation sets in immediately after the operation and the patient wakes up with dry and warm hands. As a rule, the success is excellent with sweating of the hands as well as the armpits. Due to the gentle procedure, the nerve is not destroyed and the previously frequent compensatory sweating in other parts of the body is no longer a problem.

How long does the hospital stay last and what should be considered after the operation?

We do not use any drainage during the operation, so that the procedure can generally be performed on an outpatient basis. To minimize the risk, a lung X-ray should be performed after an observation phase of several hours after the operation. It is therefore generally advisable to spend the night after the operation in the hospital.

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