Hyperhidrosis (sweat on hands) surgery: procedure and prices

Humans sweat to regulate our body temperatureBecause heat, intense physical exercise or even eating spicy foods are events that can increase our sweating rate. Although it may not seem like it, a healthy individual perspires an average of 1 liter of liquid a day, but since most of the sweat evaporates, we do not perceive it.

According to the areas that perspire this mixture of water, mineral salts, lactic acid and urea, we can differentiate three types of sweating: palmar, axillary and facial. Some places produce this type of liquid more regularly than others, as many of us are more familiar with armpit sweating than palmar or facial sweating, for example.

Even so, a certain percentage of the population experiences atypical sweating patterns: this is the case with hyperhidrosis. Fortunately, there are surgeries that, effectively, end with this clinical picture in 95% of cases. Continue with us if you suffer from hyperhidrosis, as we assure you that your condition has a solution.

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What is hyperhidrosis?

Hyperhidrosis is defined as abnormal or excessive sweating which does not necessarily correspond to high temperatures or physical exercise. In these cases, the body produces sweat in response to environmental conditions or emotional stimuli that greatly exceed physiological ones.

A patient with hyperhidrosis will sweat from the feet, armpits or hands even in air-conditioned environments, where it is not normally expected. This, of course, implies serious psychological, social and professional dysfunctions: the fear of shaking hands with a boss and that he gets drenched in sweat is, without a doubt, a fear with which all people with hyperhidrosis will identify.

Causes of primary hyperhidrosis (not due to medical conditions such as infection, for example) are unknown, since the patient's sweat-producing glands are completely normal. Even so, the nerves responsible for sending the signals that promote perspiration become hyperactive, despite not having received stimuli that indicate the need for it. It is believed that this condition may have a certain hereditary component.

Finally, as far as terminological definition and epidemiology are concerned, we are interested in showing you some data collected by various studies:

• In the United States population, the prevalence of hyperhidrosis (number of people affected in the population) is 2.8%.
• In certain specific areas of China, this value increases dramatically, to 4.6%.
• In general, hyperhidrosis is estimated to affect 1-3% of the world's population.

With these data we want to make one thing clear: you are not alone. This condition is relatively common and can be extremely annoying from a social and professional point of view, which is why wanting to seek solutions is more than justified. 3 out of 100 people suffer from it.

Various medical portals also emphasize that hyperhidrosis goes far beyond excessive sweating. Excess sweating can generate various responses in the patient. Some of them are the following:

• Modification of habits and difficulty in performing certain tasks (fear of exercising, changing clothes to try to avoid sweating... etc).
• Upset and discomfort.
• Low self-esteem and problems establishing social relationships.
• Blisters on the skin and secondary infections caused by too moist skin.

A patient is considered to have primary hyperhidrosis when this abnormal sweating occurs at least once a week, during the day, and usually on both sides of the body. It should be noted that this event should not be confused with secondary hyperhidrosis, a sweating that is due to a disease (diabetes, menopause, infections or some types of cancer, among others).

In the following sections, we will tell you how the surgery that solves hyperhidrosis works.

Hyperhidrosis surgery: a definitive solution

As we have said before, surgery effectively ends sweating in 95% of cases. Unfortunately, it is a slightly more invasive procedure than the patient might expect, as it is time to go through the operating room and apply general anesthesia to the client. for 1-3 hours.

The procedure: endoscopic thoracic sympathectomy

The procedure, generally known as endoscopic thoracic sympathectomy, is as follows. First, the professional should make 2-3 cuts in the armpit area on the side of the body where excessive sweating is occurring. The lung on this side must be deflated (collapsed), as this will allow the professional to act much more comfortably and perform the necessary tasks on the patient.

After the cuts and lung collapse, the professional will insert a tiny camera into the chest, as this video-assisted thoracoscopy (VATS) will allow you to identify the nerves that control sweating in the problem area. Once detected, it will proceed to cut them, hold them, or destroy them.

This is the truly key step in the operation, because if there is no nervous stimulus, the eccrine glands stop producing excessive sweat on the hands (or the area of ​​interest). Once the procedure is finished, the lung is re-insulated and the same way is done on the other side of the body. To check a correct lung expansion, a preventive chest X-ray is performed and, if all is well, the patient will be able to return to his room in the hospital facility.

Usually, a few hours after the operation, the normal diet is restored and the individual is encouraged to move, in order to obtain a faster recovery. After 24 hours, the patient is ready to go home.

It should be noted that, however invasive this surgical intervention may seem, contraindications are few and the individual will be able to return to a normal life as soon as the pain ceases, that is, a few days after the operation. He will have to wait 10-15 days to exercise, although he can return to work as soon as his body allows it.

On the other hand, it is also necessary to emphasize that there is another alternative to endoscopic thoracic sympathectomy. The patient may opt for an injection of botulinum toxin (botox), which blocks nerve transmission without the need to cut the nerve. Hit it? Which is temporary, as it lasts for about 6-8 months.

Adverse effects

Portals that perform endoscopic thoracic sympathectomy (such as the FAVALORO foundation) warn us that there is a relatively common side effect of surgery: compensatory sweating.

Unfortunately, the patient's body can "decide" to exaggerately perspire in another area of ​​the body after the overactive nerve causing the problem has been severed. For example, if the individual had hyperhidrosis in the palm of the hand, after the intervention they could sweat exaggeratedly in the palm of the foot. This sweating can be mild or severe and you cannot predict whether or not it will occur or where it will happen. It is up to the patient to weigh the probabilities of this event and what they entail.

Other medical portals collect other possible adverse effects that are much more worrisome: accumulation of blood or air in the chest, damage to arteries or nerves, slow heart rate or pneumonia. As strange as these events may be, it is our obligation to report them.

As you can imagine, the possible side effects of botox treatment are much less, as the procedure is less invasive and is based on a series of injections that are applied in about 20 minutes, which can be performed at the dermatologist himself. Unfortunately, as we have already said, this is a temporary solution.

Price

Endoscopic thoracic sympathectomy usually costs around 4,000 euros ($ 4,750), while botox injections can be given for about 400 euros ($ 475). Indeed, the surgical intervention costs 10 times more than the dermatological one.

It's all a matter of weighing the pros and cons of each of the options: thoracic sympathectomy is for life, while the botox is used at specific time intervals of interest to the patient or, eventually, with multiple interventions in the clinic dermatological.

Resume

As we have seen, there are three possible solutions to hyperhidrosis: living with it, undergoing surgery or a series of injections at the dermatologist. Of course, the last of the routes seems the most seductive but, if the patient wants to address the condition permanently, he has to resort yes or yes to endoscopic thoracic sympathectomy. We have informed you. From here, you decide.

Bibliographic references

• Callejas, M. A., Grimalt, R., & Cladellas, E. (2010). Update on hyperhidrosis. Actas Dermo-Sifiliográfica, 101 (2), 110-118.
• Hyperhidrosis surgery, FAVALORO.com foundation. Picked up on November 9 in https://www.fundacionfavaloro.org/cirugia-la-hiperhidrosis/
• Endoscopic Thoracic Sympathectomy, MedlinePlus.gov. Picked up on November 9 in https://medlineplus.gov/spanish/ency/article/007291.htm#:~:text=Es%20la%20cirug%C3%ADa%20para%20tratar, the% 20hands% 20o% 20the% 20face.
• Villagra, P., & Ribas, J. (2004). Surgical treatment of hyperhidrosis: bilateral endoscopic thoracic sympathectomy. Folia dermatol Perú, 15 (2), 115-120.