Indications

The decision on the surgical treatment depends entirely on the degree of distress if the patient, because the objective mediums to measure the sweat and flushing are not significant and are difficult to quantify. The results of the procedure should be weighed against the potential complications risk and side effects.

Previous thoracic surgery, obesity, older age and other illnesses associated reduce the chances of success of surgery and increase the risk of possible complications. We do not recommend surgery to patients who have 15% or more over their ideal weight, because of the difficulty and / or inability to identify the sympathetic chain during the intervention. It is very probable that after the surgery, the expected results may not be obtained.

Medical Management

Around the world, many treatments for the clinical treatment of hyperhidrosis have been tried, but they were all palliative with temporary effects or limited results.

Recently, the surgical procedure has been considered as definitive. There are just few non-surgical options to treat the hyperhidrosis, such as: Dermatologic treatments that control the sweating by the daily use of special mixtures or astringents creams.

Salty water electrical baths, for the affected area to decrease the sweat secretion for periods of 6 hours to one week; the application of botulinum toxin (BOTOX) under the skin, which works for 4 up to 6 months, but 50 painful injections in each palm are required, as well as the high prices this product conveys.

The psychological treatment, sedatives and the use of specific drugs to reduce the sweating might help the patient with Facial Blush and social phobia. However, pshycologic problems tend to be a consequence of hyperhidrosis, not the cause, and the continuity use of these medications side effects, do not help the patient at all.

In general, surgery is normally contemplated only when the less invasive medical treatments have failed to provide adequate treatment although they have the highest percentage of success.

Surgical Management

Since 1926, doctors practice surgery to treat hyperhidrosis (Sympathectomy).

Recently, the evolution of technology in video surgery, anesthesia and surgical instruments, develop an efficient, minimally invasive procedure, anatomically more precise, cosmetically acceptable and associated with low rates of complications. Surgical treatment of hyperhidrosis involves the removal, destruction or for a minimal portion clipping, more specifically, the sympathetic chain to treat.

The surgery is performed under general anesthesia with simple and / or selectively intubation to the lungs. Two Endoscopic instruments, close in diameter to a pencil (0.5 centimeters), are introduced into the thoracic cavity. One of them has a TV camera inserted showing clearly, accurately and lighting structures to be operated. The other one is used to introduce the surgical instruments needed to perform the operation. The lung is separated and the sympathetic chain located behind the ribs, near the spine, is identified. A portion of the chain is resected, thermocoagulated or clipped. Both sides are operated in the same session. The procedure lasts about 20 minutes on each side.

Very rare;(less than 1%). At the end of the 1980s, the Endoscopic Thoracic Sympathectomy began being employed more often. In the period from 1987 to 1997, it had already been operated on more than 3,500 patients worldwide. In studying the publications from different countries (China, Israel, France, Sweden, USA and others), you can see that they are extremely rare cases with serious complications or that involve risks of life of patients. Small bleeds for emptying the air from the lungs occurs in less than 1% in patients. These situations, however, are easily resulting simply keeping a pleural drain for a few days.

Scars

Small axillary and thoracic scars result from the sympathectomy surgery in men	Small axillary and thoracic scars result from the sympathectomy surgery in women