The human body normally produces sweat, as a physiological need, to regulate body temperature; from 5 million sudoriparous glands, 2 million are located in the hands. This whole sweating process is entirely controlled by the Autonomous Sympathetic Nervous System, that descends along the thorax, forming at each side a small chain that resembles a rosary. Stimulus like stress, heat, exercise, produce an instant order by the Hypothalamus (a part of the brain), which is transmitted to the sudoriparous glands by the nervous fibers that form the Sympathetic Nervous System.

Primary HYPERHIDROSIS consists on excessive sweat production, without increased external temperature or any other illness (hyperthyroidism, obesity, cancer treatments, etc…). The sympathetic system is over-stimulated; sweat is mainly produced in hand palms, and to less extent, in axillas, face and foot soles. 

HAND HYPERHIDROSIS is a very frequent problem (0.75% of people); it causes a lot of trouble to persons who suffer from it, in their social life (fear of hand shaking, for instance), at work (secretaries, artists, architects, physicians, etc.). Some patients even suffer from  important self-esteem problems. It is frequently associated to AXILLAR, FACIAL HYPERHIDROSIS,  and FACIAL FLUSH, and to lesser problems, as hand finger swelling, for example.  

There are many treatments for excessive hand sweat (HAND HYPERHIDROSIS):

Drugs and medications, with uncomfortable side effects, electrolysis, which provides temporary relief in minor symptoms cases, laser surgical resection, axilla liposuction, psychotherapy, hypnosis, Botulism Toxin injections are currently used and also provide temporary relief (at hands and axilla); however, they are both expensive and painful, and require frequent sessions to control the problem. None of these treatments definitively control HYPERHIDROSIS.

Surgical resection or cauterization of the Sympathetic System chain, at both sides of the thorax, provides a definitive cure of HAND HYPERHIDROSIS for practically 100% of patients; this is proved by a wide scientific research (See Complementary Readings at the end). 

These concepts were known for a long time, but it was extremely difficult to perform surgery at both sides of the thorax, due to the available technologies.

The appearance of new, advanced surgical techniques like almost non-invasive Surgery and surgery supported by video cameras,  which include VIDEOTHORACOSCOPY, makes SYMPATHECTOMY BY VIDEOTHORACOSCOPY the perfect treatment for HYPERHIDROSIS.

                                   SYMPATHECTOMY BY VIDEOTHORACOSCOPY                    

This procedure must be carried out in an operating room, under general anesthesia. A little below  the right axilla, surgeons make a small incision (less than a centimeter); a small optic fiber minicamera  is introduced; this way, surgeons get a perfect sight of the thorax. 

Once the SYMPATHETIC chain is located, surgeons, assisted by special tools that are introduced through the incision,  do a resection or cauterization of the Sympathetic Chain, by the third rib (T3), in case of  HAND HYPERHIDROSIS, or by the second and third rib, in case of Axillar or Facial Hyperhidrosis or Facial Flush (Sympathetic ganglions T2 and T3 are the ones in charge of stimulating sweat production in these body areas). Then, the whole procedure is carried out at the opposite side of the thorax. 

In most cases, there is no need of placing any drainage at the thorax; which allows patients to return home on the same day of surgery. In a few cases, patients must stay at the hospital for 24 hours more. 

Of course, as in any surgery, there are some risks involved, but this procedure is Very SAFE, and well tolerated by patients. Surgery takes from 40 to 60 minutes.

Symptomatic relief is immediate and complete: Patients feel dry hands when they awake from anesthesia,  this condition remains like this permanently.

Success is total in almost 100% of cases, for HAND HYPERHIDROSIS.

Sweat is reduced by 80% in axilla and face. Though this treatment is not intended for foot sweat, 50% of patients get a big reduction of sweat there. 

Post-operative pain is moderate and can be handled by oral analgesics. Job and exercise inability  is usually shorter than a week. Scars are hardly noticeable and require minimum care. Complications, such as infection, bleeding or pneumothorax (air outside lungs) are not frequent. Horner’s Syndrome is extremely rare (less than 1%), because the surgery area is far away from the ganglion whose damage would cause it.

There could be side effects: The main one consists on an increase of sweating in other body areas, as a compensatory effect (Compensatory Hyperhidrosis),  specially in back, abdomen,  thighs,  or joints. This condition happens to 85% of patients, but it is usually moderate. It is directly related to high temperatures in the environment.  However, this side effect is extremely small, in comparison to the excellent results in controlling HAND, FACIAL AND AXILLAR HYPERHIDROSIS. 

Recent surgical advances, including the resection of  the sympathetic ganglion T3 only, has proved to be very successful, regarding side effects. There could be sporadic periods of hand sweating, after surgery, that last only a few hours, and finally disappear, permanently. 

Our medical staff performs this kind of surgery  in Colombia (Bogotá and Medellín), and in Santiago de Chile.  Experience gathered by us in two years of practicing this procedure, leads to very high safety standards during the whole surgery. 

In conclusion, this surgical procedure provides a definitive cure for patients with excessive hand sweat  (Hand Hyperhidrosis), and a major improvement for Axillar and Facial Hyperhidrosis and Facial Blush, together with very high safety and excellent patients’ satisfaction. 

For more information, please contact Dr. CAMILO OSORIO BARKER, in Bogotá, Universidad de la Sabana, phone  (57 1) 861 5555, ext. 2605; at the Fundaciòn Cardioinfantil, phone  (57 1) 667 2767, or in Medellín,  at Soma Clinic, Phone (57 4) 513 3721, Office 318, or if you prefer, you may contact Dr. Osorio at his E-mail address: caol@epm.net.co