All You Need To Know About Hyperhidrosis Surgery

What is the surgical treatment for hyperhidrosis?

Hyperhidrosis is a condition where that results in excessive sweating due to causes not related to physical activity or heat. It affects individuals in all climates and can be classified into either localised (affecting one specific area of the body) or generalised (affecting the whole body). Hyperhidrosis tends to affect areas such as the hands, feet, underarms, and the face, and tends to affect both sides of the body.

Sweating is controlled by a group of nerves called the Sympathetic Chain, which runs parallel to the spinal cord. The nerves send signals to the sweat glands in the palms and axilla (armpit) that result in sweat production.

Treatment for hyperhidrosis can be divided into medical and surgical treatment.

• Medical treatment usually provides only temporary relief of symptoms for a period of about 6 months. It consists of prescribing medical antiperspirants and neurotoxin injections to block nerves supplying affected sweat glands. Iontophoresis is also an option and involves placing the affected areas in a bathtub, passing electrical currents. All these treatments usually provide temporary relief.

• Surgical treatment is a definitive and permanent solution for hyperhidrosis. There are many ways hyperhidrosis surgery in Singapore can be carried out, and this includes removing affected sweat glands or severing the nerves supplying the sweat glands that result in the overproduction of sweat (sympathectomy).

At ICTS, the surgical option to treat hyperhidrosis is known as a Bilateral VATS Cervical Sympathectomy. It is a minimally invasive surgery that involves only very small cuts [3mm] to the chest. Like all surgeries for hyperhidrosis, it is a permanent solution to the problem and involves severing the nerves that supply the sweat glands in the chest with the use of special surgical instruments. This will stop the signals from being transmitted to the sweat glands, thereby preventing sweating.

The surgery is done on either side of the body by making two small cuts on either side of the body, about 3-4mm each. The cuts will be on the chest, below the armpit. One cut is for the insertion of the surgical instrument and the other for the camera. The sympathetic chain is visualised on the camera (which runs on the heads of the rib), and the main points of the target to be removed over the 2nd and 3rd rib will be identified. Using thermoenergy (electrocautery), the nerves will be disconnected on both the 2nd and 3rd rib. Successful sympathectomy is verified by a rise in temperature in the palms later.

Once the surgery is over, the instruments are removed, and the incisions are closed using skin glue. No suture is required; thus, the surgery will be nearly scarless. The ETS surgery usually takes around one hour (30 minutes on each side), and patients usually can go home on the same day, 4 hours after the surgery. The procedure is done under general anaesthesia.

What are the risks of surgery?

Like all surgeries, cervical sympathectomy involves some risks. This includes bleeding, infection, and injury to surrounding structures. While small, there may also be a chance of failure, or recurrence of hyperhidrosis. There may also be some risks associated with general anaesthesia such as stroke, heart attack, and lung injury. However, these risk factors are dependent on each patient’s medical profile and will be discussed more with an anaesthetist before the operation.

However, the risks are low overall as the surgery is minimally invasive and disruption to normal life is minimal. The surgery is very safe and complication risks are all less than 0.5%-1%.  

How successful is hyperhidrosis surgery?

A sympathectomy is a permanent solution to hyperhidrosis. The success rate differs between patients and also between different areas affected by hyperhidrosis. If properly done, however, these nerves will not grow back again. The disconnection is permanent.

There is an 99-100% success rate in helping to resolve excessive sweating in the palms, 66% for armpit sweating, and 33% for sweating for the soles of the foot^[1]. This is to be expected as ETS is mainly to target sweating in the upper half in the body, such as in the palms and armpit. What are the side effects of hyperhidrosis surgery?

The term, “side effects” is a misnomer. Patients who have hyperhidrosis tend to have a higher body core temperature, and the mechanism for cooling is typically through their arms and axilla. Because the surgery stops sweating in these areas, alternative places in the body will have increased sweating in a phenomenon known as compensatory hyperhidrosis, in order to cool down the body. Common areas affected include the back, abdomen, thighs, and legs. However, this lasts for about 3-6 months and will go away. Only 1% may have persistent compensatory hyperhidrosis.