Effective treatment of hyperhidrosis (excessive sweating) by laparoscopic intrathoracic sympathectomy

“My hands and feet now feel dry, and I am more comfortable and confident in social situations. FV’s service before, during and after surgery is excellent, and I am very satisfied with the care I have received. This is why, for many years now, I have placed my trust in FV to take care of my health, and that of my family,” says Mr L.P.L. (35 years old, from Vinh Long) after undergoing sympathectomy to treat hyperhidrosis at FV Hospital’s Vascular Surgery Department.

Mr L. visited FV in April 2021 because he had experienced excessive sweating on his hands, feet, chest and armpits since he was 16 years old. Although he had previously consulted with and received a treatment direction for his condition from a doctor at a provincial hospital, he  choose to come to FV for care.

“A lot of sweat from my hands and feet means I am always wet and uncomfortable. I was not even confident when shaking my partner’s hand, so when I was ready to go to FV for a medical examination, I decided to choose this centre to completely treat this disease,” shares Mr L.P.L.

At FV, the patient was examined by Dr Luong Ngoc Trung at the Vascular Surgery & Phlebology Department. After diagnosing Mr L.’s condition, Dr Trung advised that he have his sympathetic ganglia removed to treat the patient’s excessive sweating.

“When Dr Trung gave me advice, I knew from his ideas and enthusiasm that I had come to the right place. However, I had some issues to deal with at my business in my home town, so I made an appointment to see Dr Trung two weeks later to have the operation,” Mr L. explains.

Mr L. returned to FV for his scheduled surgery: bilateral thoracic sympathectomy performed by the endoscopic method video-assisted thoracoscopic surgery (VATS), with two or or three trocars measuring five millimetres introduced under selective endotracheal anaesthesia. The surgery was completed successfully in 60 minutes, with no bleeding or complications, and the patient was discharged the next morning. After one week of follow-ups, Mr L.’s hands and feet were no longer sweaty, and instead were completely dry.

Dr Trung says that bilateral thoracic sympathectomy with VATS only takes 30-40 minutes on average, but in cases of obese patients such as Mr L. the surgery will be more difficult and prolonged due to issues such as thickening of the chest wall, hypoxia when breathing with one lung, and visceral fat covering the sympathetic ganglia.

Increased sweating can be most often be seen in the extremities, armpits, face, and chest. Excessive sweating from the hands is often the most annoying because it negatively impacts how people work, their quality of life, and their confidence in social interactions. Patients may also experience some special complications such as peeling skin, inflammation and fungal infections. Causes may be primary (sympathomimetic) or secondary (after trauma, infection, medical disease, tumours, or hyperthyroidism.)

Conventional treatment is indicated after puberty. Treatment includes changing life habits, eliminating risk factors, administering drugs (oxybutine, anticholinergics, Botox injections) and destroying sweat glands by microwaves or surgery, but often results are short-lived.

Currently, thoracic sympathectomy is the optimal treatment because it helps to improve hyperhidrosis, in which thoracic sympathectomy through VATS has been proven and agreed via a small incision of around one centimetre, low risk of complications and a short recovery time following surgery. The effectiveness of this treatment improves the patient’s ability to work efficiently and to enjoy a better quality of life.

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