Hyperhidrosis Info
Informations about hyperhidrosis for patients and health professionals
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Video Endoscopic Sympathectomy
The videoendoscopic Sympathectomy is performed under general anesthesia. A
stem is introduced through a small cut in the thorax. With the aid of the
video, the surgeon identifies the sympathetic nerve. Through a cautery, the
responsible nerves for Hyperhidrosis are destroyed. The technique is efficient,
with excellent results. But it presents complications, among them, the most
frequent one is the Compensatory Hyperhidrosis (a sweating increase in other
parts of the body), that it is a very unpleasant situation.
The surgical treatment of Hyperhidrosis, the Sympathectomy, involves the removal
of a specific part of the main sympathetic nerve. It is well knon that the
sympathetic nerves are part of a separate and parallel nervous system. The
anatomical position and the function is separate from the somatic nerve system(volunteer),
which are the nerves that control the sensations and the movements. The "chain" of
sympathetic nerves is formed by a group of nerves located close to the ribs
in the thorax. They are very close to the spine. The nervous branches, that
leave the ganglions, reach the gland and stimulate the sweating. There is a
ganglion in each vertebral level of the spine and all these ganglions are attached
one to another longitudinally forming the "sympathetic chain". The
branches of the sympathetic nerve come off each one of these ganglions and
they will act on the blood vessels and sweating glands in the body. The surgical
therapy for Hyperhidrosis requests the removal and destruction of this specific
ganglion that cause the sweating of the hands and armpit. There is a variety
of manners of working with the sympathetic ganglions: removing, cauterizing,
or cutting the branches. All of these techniques are capable to block Hyperhidrosis.
In the classic technique to treat Palmar Hyperhidrosis (hands), the ganglion
of T2 is moved away or destroyed. Many surgeons will also remove the third
ganglion to maximize the chance to stop the sweating of the hands completely.
To treat the armpit, the second and third ganglion is moved away or destroyed.
Just the same, some surgeons will also destroy the fourth ganglion to maximize
the result. To reduce the possibility of Compensatory Hyperhidrosis, the ganglions
are being more selectively chosen. But this does not guarantee that compensatory
Hyperhidrosis won't happen and it increases the chances of reoccurance of Hyperhidrosis.
In the past, an incision of larger size was used in the thorax or in the lateral
of the neck. That demanded cuts with scars to expose the sympathetic chain.
However, recent progresses in technology produced less invasive methods, such
as the videoendoscopic Sympathectomy. This requests general anesthesia for
the patient. Once asleep, two or three small holes (5-10 mm) are performed
in the thorax. Through these holes, an endoscope with a video camera sends
images to the doctor. With this technique, the sympathetic chain can be identified.
Through the incisions, instruments are intrduced to allow the surgeon to remove
and destroy the specific ganglions, depending on the patient's symptoms. To
perform this operation, the patient's lung has to be collapsed to allow appropriate
space for the surgeon to maneuver. After the conclusion of the operation, the
lung is refilled and the incisions are closed. Occasionally, a small tube is
maintained inside the thorax to allow evacuation of air, however, that is removed
some hours after the surgery. After a side is completed, the surgeon repeats
the procedure on the opposite side
Usually, the patients leave the hospital in a period of 24 hours following
the surgery. There is some post-operative pain, which requires medication for
some days.
Naturale Clinic’s Treatment
Many patients can benefit from the Sympathectomy, but some few ones can not. As the problems resulting from the surgery are unexpected and do not depend on the doctor who performs the surgery, we prefer to treat Hyperhidrosis with the Botulinum Toxin (BOTOX® / Dysport) because it does not cause neither Compensatory Hyperhidrosis nor Syndrome of Horner, and there are no surgical complications.
If the choice is safety, the best option is the Botulinum Toxin (BOTOX® / Dysport) injection. If the choice is the fact of being definitive, the best option is Sympathectomy, in spite of its important risks and possible complications.
Existem 2 técnicas eficientes para tratar a Hiperhidrose:
A Toxina BotulínicaA Simpatectomia
A Toxina Botulínica, que preferimos, tem poucos riscos, mas não é definitiva, a simpatectomia é definitiva, mas tem maiores riscos e complicações.
Assim, como as duas técnicas são diferentes, e ambas são eficientes, o médico deve explicar ao paciente as vantagens e desvantagens de cada técnica e a escolha deve ser opção do médico e do paciente
A Simpatectomia
A principal vantagem da Simpatectomia, é de que é um procedimento definitivo.
As desvantagens são os riscos de uma cirurgia, a Hiperhidrose compensatória, a Síndrome de Horner, O Pneumotórax, o Hemotórax, a assimetria de resultados, resultados imcompletos, complicações anestésicas, necessidade de internação hospitalar, anestesia geral, não é reversível, é uma técnica de maior complexidade, e utiliza material complexo.
A Toxina BotulínicaA principal desvantagem da Toxina Botulínica é de que não é um procedimento definitivo, tem um custo relativamente elevado por não ser definitiva, e apresenta um pequeno índice de falhas.
As principais vantagens são: É um procedimento ambulatorial, que não necessita internação, é reversível, é simples, o material é simples, a técnica tem baixo risco, não provoca hiperhidrose compensatória, não tem síndrome de Horner, não tem complicações cirúrgicas, é realizada sob anestesia local, no consultório.
Na Clínica Naturale , preferimos a Toxina Botulínica porque é um tratamento simples, para um problema simples.
More about BOTOX® Treatment for Hyperhidrosis
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