Treatment: Surgical Methods

The idea to surgically treat increased sweating could at first glance seem to be weird to both healthy people and doctors. But patients suffering from increased sweating take it as hope to finally be saved from the disease. Those patients who begin to think of surgical treatment know what the inefficiency of conservative methods variety feels like. They are patients who do not want to put up with constant discomfort and stress in their lives.

Operative interventions can be divided into two groups. The first group comprises operative interventions performed directly in the problem area (these operative interventions are only possible in case of underarm (axillary) hyperhidrosis). The second one is operative interventions on nerve ganglia.

1. Operative Interventions in the Problem Area

— The Excision of Skin from the Glandular Area

In the sixties of the last century there was offered an operation which presupposed the excision of skin in the underarm area along with the glands hyperproducing sweat. In spite of the surgery traumatism and cicatricial deformations in the post operative period, such intervention was much in demand. It makes quite clear what the patients suffering from hyperhidrosis are ready to do to get rid of the problem of uncontrolled increased sweating in the area of axillae.

— Open Adenotomy (Scoog Surgery)

After awhile there was offered a method of open adenotomy, when the skin is cut in the underarm area and subcutaneous tissues along with glands are excised. The skin is sewn up. Scars and possible disease recurrence are the disadvantages of this operative intervention.

— Sweat Gland Suction

In the eighties of the last century there was offered a method of the axillary sweat gland removal by cannulae with the openings turned towards the skin. The method presupposes two incisions up to 5-6 mm. The effect is predetermined by the skin denervation. Glands which hyperproduce sweat are removed at the same time. The method is low-traumatic and leaves no scars. Its disadvantage is a possible disease recurrence, since the innervation periodically recommences and a common cannula removes glands inadequately.

— Ultrasound-Assisted Suction Adenectomy

The use of ultrasound technologies gives the opportunity to destroy glands in the subdermal layer more adequately, as well as to destroy cells of the excretory gland duct located in the skin mass. Ultrasound also leads to derma hardening. These processes prevent the disease, making the development of glands in the postoperative period impossible.

— Curettage Method

In our clinic we have developed and patented a special suction cannula for an active curettage of glands in a given subdermal layer (patent No. 28997). We use two incisions up to 5 mm to perform curettage by a special cannula 4 mm across diameter. The cannula is somewhat oblate and has active openings of a special configuration.

— Combined Ultrasound-Assisted Mechanical Curettage with Endoscopic Video Control

This method consists in the use of ultrasound technologies (the equipment of Sonoca Lipo Gmbh) and a patented cannula specially developed in our clinic. The process is controlled by endoscopic video monitoring (the equipment of Karl Storz). It is extremely important, since video control gives the opportunity to perform the procedure within clear-cut boundaries and determines the dosing of ultrasound impact and mechanical curettage. This combined approach gives the opportunity to reduce risk, as well as to achieve the maximally possible result.

2. Operative Interventions on Nerve Ganglia

— Open Sympathectomy

It was in 1920 when the open removal of sympathetic ganglia was performed through the posterior surface of the neck. The method gave the opportunity to exclude the problem area innervation, which lead to the decrease in sweating. Nowadays this method is not used, since it has been replaced by video endoscopic technologies.

— Endoscopic Thoracic Sympathectomy

This method presupposes the destruction or clip application on sympathetic ganglia through small incisions in the thoracic area using thoracoscope 2-8 mm across diameter. More precise work is performed on the radicles coming from ganglia preserving sympathetic trunk. Sympathectomy is as a rule performed in the Т1-Т2-Т3-Т4 area of thoracic ganglia. The treatment of primary palmar hyperhidrosis is more effective and has fewer complications. In general, encouraging publications about the efficacy of thoracic endoscopic method in the treatment of primary hyperhidrosis were replaced by alarm information.

Such complications typical for any interventions in thorax as pneumothorax, haemorrhage, wound abscesses and the like are rather rare (1-2%) in the surgical treatment of hyperhidrosis.

However, such complications or side effects as compensatory hyperhidrosis (increased sweating in the areas adjacent to the problem ones or in the remote parts of the body), increased sweating at he time of food consumption and Horner’s syndrome (eyelid droop) are rather common. According to different authors (Rietm, T. S. Lin), 30-97% of people who undergo sympathectomy have such complications to one degree or another.

In case of marked compensatory sweating, a number of patients regret for the performed operative intervention (F. S. Baymgarther, Y. Toh).

— Percutaneous Puncture Stereotaxic Thermocoagulation of the Upper Thoracic Ganglia

On the basis of topographic anatomical data, surgeons Dr. K. S. Chuang and Dr. J. C. Liu have developed a system of reference which allows clear determination of the location of probe for ganglion thermocoagulation. The method has found no adherents, and nowadays it is not used because of technical difficulties and possible inaccuracies and complications.