| Surgical Intervention
Hyperhidrosis surgery has come a long way in the last decade. Traditionally, large incisions were made in the chest to surgically interrupt the sympathetic trunk, all in an effort to treat hyperhidrosis.
With the advent of minimally invasive techniques to work in the chest via endoscopes and surgical instruments, Dr. Karmanoukian and other cardiothoracic surgeons who have taken an interest in endoscopic thoracic sympathectomy have evolved a procedure which is very effective in treating patients with sweating of the hands, underarms, face, scalp as well as patients that have facial blushing.
Dr. Karamanoukian has seen over and over again, how debilitating hyperhidrosis is to both young and adult patients. Given his area of expertise in robotic surgery, he has used this technology to further minimize the surgical trauma associated with treating hyperhidrosis. Dr. Karamanoukian is the author of a dozen books in cardiac surgery and thorcic surgery. He has also written 3 books that specifically deal with topics relating to Board Certification in Cardiothoracic Surgery. He has also authored more than 130 scientific articles in the field of cardiothoracic surgery and robotics. He is Board Certified in both General and Thoracic Surgery with a specific interest in advanced endoscopic surgery and robotic surgery.
The Surgical Answer: Endoscopic Thoracic Sympathectomy
This is the most durable treatment for hyperhidrosis in experienced hands. Clipping the thoracic sympathetic trunk at the appropriate levels will immediately eliminate hyperhidrosis. It is quite dramatic to see a patient wake up from anesthesia and to take note of a dry hand or axilla. With modification of the level of sympathectomy, compensatory hyperhidrosis is also minimized or eliminated.
Medical Therapy
Astringents
Conservative medical treatments such as Drysol and Drionics are the initial treatment for hyperhidrosis. These medications are astringents that dry up the sweat glands.
Topical Antiperspirants
These agents are applied directly to the skin in the affected areas of the body and can cause skin irritation. They are quite messy on clothing and unfortunately, have short periods of efficacy, requiring frequent reapplications.
Anticholinergic Medications
Anticholinergic medications aim to suppress the cholinergic stimulation of the eccrine sweat glands by the sympathetic nerve trunks to eliminate or reduce excessive sweating. However, they can cause significant adverse effects, limiting their usefulness.
Iontopheresis
Iontopheresis is an alternative treatment which utilizes an electrical stimulation to the hands. Patients are instructed to bathe thier hands in an electrolyte containing solution through which an electrical current is passed. This "stuns" the sweat glands of the hand, in effect decreasing the "sweat reflex" for periods of hours to weeks. Most patients find this mode of treatment as ineffective and not of durable benefit.
How About Botox?
Is Botox only for the rich and famous? Injection of botulinum toxin (Botox) into the area of excessive sweating has been shown to cause temporary benefit in hyperhidrosis. Botix affects nerve endings and decreases the transmission of nerve impulses to sweat glands, effectively reducing the production of sweat.
Multiple injections in the palms of the hand or armpit have been described as "painful" by most patients and quite costly as most health insurance companies do not pay for these treatments. Repeated injections are nearly always required to maintain an adequate level of dryness.
In general, surgery is contemplated only when the less invasive medical treatments have failed to provide adequate treatment. This is an important point, as most insurers want documented failure of conservative therapy before endoscopic thoracic sympathectomy is approved. |
