Hyperhidrosis is classified by sweating excessively in response to stimuli. Excess sweat is define as sweat that exceeds amounts normally needed to cool down elevated body temperature.

Hyperhidrosis can be classified as either primary or secondary. Primary hyperhidrosis is generally localized to specific locations including the face, armpits, palms, and soles. Secondary hyperhidrosis is more generalized throughout the entire body and is usually caused by another existing medical condition. Although not fatal or life-threatening, hyperhidrosis can lead to severe psychological, social, and occupational issues.

Since secondary hyperhidrosis is caused by other medical conditions, treatment for this type of hyperhidrosis lies in the treatment of these conditions. Primary hyperhidrosis, on the other hand, must be treated symptomatically. Initially these treatments should be non-surgical and should include topical treatments like aluminum chloride, iontophoresis, oral medications like anticholinergics and botulinum toxin. If these non-surgical treatments do not yield sufficient or desired results, then surgical treatments can be considered.

There are three main surgical treatments that can be performed to help manage hyperhidrosis. They are excision of the sweat glands, subcutaneous excision of the sweat glands, and sympathetic block. With the first two treatments, the procedure centers the localized excision, curettage, or liposuction of the sweat glands. The final procedure, thoracoscopic sympathectomy, actually alters the way the sympathetic nervous system communicates with the eccrine sweat glands.

The sympathetic trunk, which contains 12 ganglia, passes through the thoracic region. In this region, sweat glands are arranged segmentally, meaning that each ganglion branch communicates with a localized region. During a thoracoscopic sympathectomy, a portion of this sympathetic nerve trunk in the is destroyed, reducing hyperhidrosis in a particular location. This helps to regulate excessive sweating and alleviate the symptoms of hyperhidrosis.

Complications from hyperhidrosis surgery are rare, and mortality rates are very low in comparison to other surgical procedures. Although complications rarely occur, when they do the most common complication is pneumothorax, which is the abnormal collection of air in the pleural space between the lung and the chest. This condition usually resolves itself spontaneously, but can also be treated via drainage tube.

Overall, thoracic sympathectomy has been found to be a safe and effective surgical treatment for hyperhidrosis. This procedure yields excellent results and a high level of patient satisfaction. However, success rate can be determined by the severity and location of hyperhidrosis and patients may experience different results. To be sure thoracic sympathectomy is the right treatment for your particular case of hyperhidrosis, schedule a consultation with Dr. McKenna today!

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About the Authors

Osita, M.D., MBA Onugha,

Osita Onugha, M.D., MBA, is the Assistant Professor of Minimally Invasive Chest Surgery and Thoracic Surgical Oncology at the Saint John’s Cancer Institute. Dr. Onugha is a board-certified surgeon and assistant professor of thoracic surgery at the Saint John’s Cancer Institute. Dr. Onugha practices all aspects of thoracic surgery, including procedures for benign and malignant conditions of the lung, esophagus and mediastinum. Learn More About Dr. Osita Onugha.