Surgery
There are essentially 2 operations to consider:
 | the excision of sweat glands from the axilla (armpit) |
| the excision of the sympathetic nerves that supply the sweat glands to the axilla, hands and feet |
Excision of axillary sweat glands
This involves a cut in the axilla and excision of or scraping off the sweat glands. The main complications of the operation include the possibility of excessive scarring, wound breakdown and areas of numbness in the axilla.
Thorascopic cervical sympathectomy
The sympathetic nerves that supply the sweat glands of the hands and axilla start in the chest as the sympathetic chain. The nerve junctions in the chest are in areas called ganglia and these lie across the necks of the ribs. Nerves leave these ganglia and travel to the tissues. Those for the hand and axilla travel up along the rib necks to the ganglia in the neck before traveling to the tissues. Dividing these nerves was originally done as an open operation - nowadays 'keyhole' surgery has made the operation easier and recovery faster.
Under a general anaesthetic a camera is inserted into the chest:
A very good view of the inside of the chest is obtained. An operating instrument is also inserted into the chest and the sympathetic chain can identified and destroyed as it crosses the neck of the rib:
The gas is then removed from the chest cavity to allow the lung to re-expand.
This operation also has some success (about 70%) in treating severe facial blushing. Sometimes excess sweating of the scalp occurs during these episodes. The treatment is division of the sympathetic chain as it crosses the second rib and also division of the nerves of Kuntz as they cross the second rib:
The possible complications of the procedure include:
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Complications of a general anaesthetic. |
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General complications of any operation - wound infection, bleeding, deep vein thrombosis, chest infection etc. |
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Bleeding may be severe if one the arteries under the rib is damaged or if one the veins in the chest is damaged - see photo above for the veins. |
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Horner's syndrome - this is drooping of the eyelid on the side of the operation, loss of sweating in that side of the face and changes in the size of the pupil on that side. This occurs if the sympathetic chain above the second rib is destroyed (i.e. one of the neck ganglia called the stellate ganglion). This may resolve after a few months. It occurs in less than 1% of cases. |
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Pneumothorax - this is persisting air in the chest. It may need to be drained off. |
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Pain - especially around the shoulder. |
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Compensatory hyperhidrosis - this is excess sweating elsewhere on the body (usually the trunk and legs) and can occur in 60-75% of cases if the sympathetic chain across the 2nd, 3rd and 4th ribs is divided for axillary and hand sweating. It is rare after treatment for hand sweating alone where the sympathetic chain across the 2nd rib alone is divided. It may be difficult to manage and can sometimes be distressing for the patient although many consider it a minor inconvenience. It may settle 1-2 years after the operation. |
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Excessive dryness of the hands can occur such that moisturisers are needed. |
Lumbar sympathectomy for pedal hyperhidrosis
The sympathetic chain near the back bone is divided. There is a high rate of impotence in men following this operation and therefore it cannot be recommended. It has been effectively used in women however.