Treatment with Regional Excessive Sweating (hyperhidosis) and Single Port ETS
What is Excessive Sweating?
The human body sweats in order to keep its temperature at a normal level. This process is regulated by the Sympathetic Nervous System, which controls about 5 million sweat glands in the body.
Sympathetic Chain Branches that control sweating are located in the chest cavity.
Excessive sweating (Hyperhidrosis) is a condition where the body sweats more than it needs.
You are about to go to a job interview or meet someone new. You suddenly feel excessive sweating in your hands and armpits. Or, you just finished your workout and noticed that your body is sweating excessively. Your body normally secretes sweat to cool itself. This is a normal situation.
However, in about 2% of people, this sweating occurs at any time of the day and in all seasons, except for sleep, not with hot weather, excitement or when exercising or exerting. This situation is Regional Excessive Sweating – It is known as hyperhidrosis.
Zones of Excessive Sweating
Excessive Sweating occurs suddenly or continuously in 4 areas of the body:
- Hands,
- Armpits,
- Feet
- Face and Hair
Symptoms of Excessive Sweating
Excessive sweating on the hands, feet, armpits or face is a deep and dramatic experience for the patient. Work and related professional activities affect all aspects of life, including activities of normal daily living and interpersonal social relationships.
Hand Sweating
At the time of first meeting with a person, sweating may occur on the hands due to tension or emotional stress. A light drying will remove this perspiration. In cases of severe hand sweating, it is observed that sweat drips from the hands. This is a condition that can be observed in childhood.
Patients with excessive sweating on the hands are constantly aware of this situation and think that they have to live with it. Generally, sweating of the hands is the most distressing symptom of excessive sweating. Many patients also report that their hands are cold and matted.
Since the hands are always visible and in the middle in social and occupational environments, many patients with excessive sweating are constantly warned and avoid social contacts. He tries to stay away from handshaking or dealing with paperwork. Patients feel uncomfortable even holding the hand of their loved ones.
Excessive Underarm Sweating: This creates uncomfortable sweat marks on the armpits of the clothes. For this reason, people avoid fabrics or colors that will show sweat when choosing their clothes.
Sweating Foot
This situation causes foot odor. In addition, it becomes difficult to drive in cases where hand and foot sweating together.
Excessive Percent Sweating
Facial sweating makes the person look extremely nervous and insecure, even though they are not. Along with facial sweating, excessive flushing can sometimes occur, which is another irritating condition.
What are the Treatment Methods of Excessive Sweating?
Primarily, antiperspirants and creams are used.
Although anticholinergic drugs are effective from time to time, side effects such as dry mouth, blurred vision, constipation and palpitations may occur due to the effect of the whole body.
In addition to these, methods called botox injections or iontophoresis are also used.
Botox applications are suitable for underarms. However, botox applications on the hands, feet and face are practically difficult and painful. It should be repeated 2 or 3 times a year.
The US Food and Drug Administration (FDA) allows botox application only for the armpits in the treatment of excessive sweating. It does not allow botox application on hands and feet!
Is There a Permanent Treatment for Regional Excessive Sweating (Hyperhidrosis)?
Yes, the only long-term and effective treatment for excessive sweating is to surgically stop the sympathetic nerve impulses from going to the sweat glands.
Simply, this process results in the treatment of all areas of excessive sweating (hands, feet, armpits and face). This procedure is called Endoscopic Thoracoscopic Sympathectomy (ETS).
ETS Method in Case of Regional Excessive Sweating
- Endoscopic Thoracoscopic Sympathectomy (ETS) procedure is performed by an experienced thoracic surgeon with only a 1-day hospitalization of the patient. The procedure is completed under general anesthesia, by placing titanium clips on the sympathetic chain in the posterior part of the chest cavity, just behind the posterior end of the ribs, with the help of a camera of the surgeon.
- This procedure for both chest cavities takes about 1 hour.
- Patients return to work approximately 3 days after the procedure.
- This method is highly effective for excessive sweating of hands and armpits
Post-Operative Images of Our Patients to whom Single Port ETS Applied
Results in Excessive Sweating Treatment
Immediate improvement in symptoms after the operation is achieved at a rate of close to 100%. In the late postoperative period, 85% of the patients show a significant regression in hand sweating. Full recovery of armpit sweating is seen in 70% of the patients in the advanced periods.
What are the Side Effects of Single Port ETS?
The most common side effect is increased sweating in other parts of the body (abdomen, back, waist or legs). However, a serious problem occurs in only 1% of patients.
In addition, a rare and temporary condition called Horner’s Syndrome may occur in the patient (3%). A 10% decrease in heart rate and presence of air in the chest cavity are other rare complications.
The incidence of these conditions is much lower in centers that have experience with the procedure.
Post-Operative Patient Satisfaction Rates?
As a result of a scientific study conducted on 170 patients in Dallas, Texas, the satisfaction rates after 1 year of the procedure are as follows (source: Dewey et al: Ann Thorac Surg 2006:81:1227-33)
| Very Satisfied: 93.3% |
| Satisfied: 5% |
| Dissatisfied: 1.7% |