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Sweating is necessary to control body temperature during times of exercise and
warm/hot surroundings. Sweating is regulated by the sympathetic nervous system.
In 0.6 to 1.0% of the population, this system is revved-up and works at a very
high level causing sweating to occur at inappropriate times in specific areas
of the body. This condition is known as hyperhidrosis.
Hyperhidrosis can occur in many different areas of the body. Most commonly,
hyperhidrosis appears on the palms. In this case it is known as Palmar Hyperhidrosis. The condition isn't just limited to
the hands. Hyperhidrosis is also a problem on the facial area, the soles of the
feet and the armpits (axillae.) Severe facial blushing may coexist.
Regardless of where it is located, hyperhidrosis presents an embarrasing
problem to those afflicted with it. Shaking hands becomes uncomfortable, making
business and day-to-day life a problem. Patients report that they are even
embarrassed to hold the hands of those they love. Patients commonly suffer from
various degrees of social phobia causing them to withdraw from normal activities.
Hyperhidrosis is also not a temporary condition. Many people who suffer from it
have suffered for many years, usually from adolescence. Also, hot or cold, the
sweating is constant.
While doctors don't know why hyperhidrosis starts, they have successfully
linked it to overactivity in the sympathetic nervous system.
Specifically, it is the Thoracic Sympathetic Ganglion Chain, which runs along
the vertebra of the spine inside the chest cavity.
This chain controls the glands, know as the apocrine and eccrine glands,
responsible for perspiration throughout the entire body. Depending on which
part of the chain becomes overactive, different parts of the body become
Sometimes people will sweat excessively because of other illnesses such as
hyperthyroidism, psychiatric disorders, menopause and obesity. These causes
must first be ruled out before Primary Hyperhidrosis can be diagnosed.
Doctors have long tried to deal with this problem. Until now, no plan of action
has produced any completely satisfactory results.
Solutions in the past have included everything from pyschotherapy to heavy
applications of antiperspirants. Psychotherapy usually did not help the medical
condition and proved to many to be a heavy burden. Antiperspirants caused the
same hardship. In order to work, they needed to be applied both regularly and
liberally, making going through the average day quite a hassle. Drugs, such as
psychotropic (sedative) and anticholinergic (atropine, robinal) medicines,
looked promising for a while. Unfortunately, these drugs presented risky and
unnecessary side effects, such as dry mouth, urinary problems and even
increased risk of heat stroke. Some patients have used electrical stimulation
which is uncomfortable and only marginally effective.
Surgery presented a more effective solution. A procedure known as dorsal
sympathectomy, done through a very large chest or back incision had been
applied for many years as a treatment for hyperhidrosis. The technique had many
problems, though. The operation was long and often involved long-term
disability, pain and high complication rates. Few surgeons recommend this
procedure for a non life threatening problem.
Recent developments have made a painful and complicated sympathectomy a thing
of the past. In the last 10 years the endoscopic approach has revolutionized
sympathectomies. A surgeon needs to make only a few small cuts in order to
insert a small camera and working instrument. With this treatment of choice, we
can eliminate hyperhidrosis in a very short time on an outpatient basis with a
superb cosmetic result.
In order to end hyperhidrosis, the surgeon must divide the overactive
sympathetic nerves that cause the excessive perspiration. Thanks to
developments in the field of endoscopic surgery, a procedure which uses small
instruments and cameras that allow the surgeon to enter the body with minuscule
incisions, the surgery can be performed with minor discomfort.
The procedure is performed on an out-patient basis, occasionally requiring a
one night stay in the hospital. The patient is placed under general anesthesia
through out the surgery, which lasts less than an hour. Recovery is also
achieved in a short time, ranging from a day to a few days. Most people are
able to return to work in week or two, depending on their individual comfort
Please note that you are not eligible for this surgery, if you suffer from
severe cardio-respiratory illness, pleural disease or untreated thyroid
Below is a more detailed look at the surgery itself:
Under general anesthesia, small incisions, approximately one
centimeter in length are made under both armpits.
Air enters through the incision into the chest cavity,
collapsing the lung.
Endoscopic equipment (a fiberoptic camera and working
instruments) are then inserted.
The surgeon locates the sympathetic nerve chain along the rib
heads and the individual nerve ganglia responsible for the particular area of
the body affected.
The endoscopic instrument is then used to divide and remove the
sympathetic nerve nodes responsible for the sweating.
The instruments are removed and the lung is reinflated.
The incision is then taped closed. No Sutures are used.
The process is repeated on the other armpit
Scarring is minimal, as the cuts made are both extremely small
and well hidden in the folds of skin in the armpit.
The results seem almost miraculous. In over 95% of all cases, the
patients hands are dry and warm right after surgery. Hyperhidrosis of the feet
is eliminated in about 60% of the cases. Facial sweating is helped in
about 65% to 75% of the cases. Rapid heart rate and palpitations are
also reduced dramatically.
For people who have long suffered from this embarrassing and troublesome
condition, the results are amazing. To get a better understanding about how
this surgery has changed some people's lives, please read some testimonials. Dr. Szarnicki has operated on over
100 patients so far. Many patients are willing to speak to new patients to
discuss their experience. You may call the office to obtain the names
and phone numbers or email addresses of these patients.
Any surgery has possible side effects, and we advise you to discuss them more
fully with the doctor.
Compensatory sweating is the most common of side effects and occurs in
20%-50% of cases. After the operation, some patients might experience
some degree of sweating in other locations such as the thighs or back. Most
patients say that they are not troubled by this extra perspiration and it is
preferable to sweaty palms. In most cases, the condition improves over
A more rare side effect, gustatory sweating, which occurs in about 10% of
cases, has appeared with some patients. With this condition, patients notice
that they tend to sweat while eating or smelling certain foods.
These side effects are regarded as a minor inconvenience and are far more
acceptable than sweaty palms.
In the many cases that have been performed, it has been shown that this
procedure is both safe and effective when performed by a qualified and
experienced surgeon. Dr. Szarnicki has been doing cardiac and thoracic
surgery for twenty years and received special training in thorascopic
surgery. The end of hyperhidrosis is here. No one ever has to deal with
this problem again.
Complications are not common for this surgery, but they may include the
Excessive Bleeding (rare)
Infection and injury to surrounding organs (rare)
Pneumothorax, a condition in which air remains in the chest
wall (common but rarely a clinical problem and usually resolves spontaneously)
Horner Syndrome is also a complication associated with this
surgery. This uncommon condition results in the dropping of the upper eyelids,
constriction of the pupils and dryness of the eyes. (Dr. Szarnicki has
had this complication in 2 patients thus far, which were temporary and resolved
1-2 months after surgery. These occurred very early in our experience.)
Numbness of armpits, upper arm and chest wall occurs occasionally
and usually resolves after a few months.
There are very few side effects. Compensatory sweating on the thighs and the
back appears in about 20%-50% of cases. This sweating usually becomes barely
noticeable after a while. A short time after the operation, some patients have
continued sweating on their palms. This is a very temporary phenomenon that
might last for half a day. Gustatory sweating, a condition in which sweating
increases while eating or smelling certain foods, develops in rare instances.
What are the risks of the operation?
No operation is without risk. Though the risks for this procedure are small,
Horner Syndrome, infection, injury to surrounding tissue, pneumothorax and
excessive bleeding are know risks. For more information on these complications,
please read more about the surgery itself.
What is the success rate?
Sweaty palms are cured in over 95% of cases. For plantar or feet hyperhidrosis
the success rate is about 60%. The success rate for facial sweating is about
What happens to the rest of the sympathetic chain?
There is tremendous overlap in function within the sympathetic chain, so there
are no know long-term side effects.
What is the recovery period?
Usually very short. After the hour-long operation the patient spends about two
hours in the recovery room and one night in the hospital. Most patients can go
home the same day and return to normal work in a week or two, depending on
their individual comfort level.
When can I have it done?
Because the operation will not require excessive time away from work, usually
less than one week, you can schedule the surgery at your convenience. A
consultation and examination in my office is required beforehand. The procedure
itself will take only about an hour.
What about insurance?
Most insurance companies cover the procedure because it is considered a medical
No salves, ointments, creams, medications or machines have provided long term
relief. ETS provides a cure in the vast majority of patients. The method has
also been truly proven.
Where is the procedure performed?
The procedure is performed in the surgery department at California Pacific
Medical Center, a leading medical center in Northern California.
Where performs the procedure?
Robert Szarnicki, M.D. is a board certified Cardiovascular/Thoracic Surgeon,
with over 20 years of experience in the field of surgery.
Am I a candidate for the procedure?
Yes, if you are otherwise in good health. You are not a candidate for the
procedure, if you suffer from severe cardio-respiratory illness, pleural
disease or untreated thyroid diseases.