The aim of sympathectomy (surgical peripheral nerve blockage) is to interrupt the nerves responsible for sending impulses for the secretion of sweat to the perspiratory glands. In theory the formation of perspiration could be shut down for the whole body with this method, in practice however, such a procedure is not possible.
Sympathectomy is only applied for facial, plantar (feet) or palmar (hands) hyperhidrosis. In the past, for the treatment of plantar hyperhidrosis, a more complex interference used to be carried out (“open belly operation”). Due to the increased surgical risks, nowadays this technique is not anymore applied. The upper extremity and the face can be treated with an endoscopic surgery. For the treatment of the armpits, even though surgically possible, other treatments are chosen these days. However, before a sympathectomy is taken into consideration, preventive measures and external treatment methods like e.g. antiperspirants should have been fully exploited in every case.
Endoscopic transthoracic sympathectomy (ETS) can be applied in case of heavy resistance to therapy of palmar or facial hyperhidrosis. Therefore a so-called minimal invasive interference, which was developed and refined in the last years at a few hospitals in Europe, is applied. Is has finally replaced the conventional sympathectomy (open surgical technique with a long cut).
The endoscopic technique bears relatively low-risk and mostly brings about satisfying results:
- Patients suffering from both perspiration on the hands and feet have a good chance that a palmar surgery leads to an improvement of plantar perspiration also.
- Isolated perspiration of the feet can only be treated with a lumbar sympathectomy, an open surgery in the abdominal cavity. Endoscopic interferences were undertaken by way of trial. However, considerable technical difficulties were encountered and a very long operation time is required without bearing substantial advantages for the patient.
- Hyperhidrosis at the torso or on the whole body cannot be treated with a surgical interference.
Hyperhidrosis of the trunk or the entire body cannot be treated with surgery.