the Risks of Hyperhidrosis Surgery: A Call for Patient Satisfaction Surveys

Q: the Risks of Hyperhidrosis Surgery: A Call for Patient Satisfaction Surveys

Hello： 1. A second or third thoracic sympathetic nerve ablation surgery will not cause anhidrosis of the head, unless the first thoracic sympathetic nerve is affected during the procedure, which could lead to such a complication. 2. Compensatory hyperhidrosis

Severe complications of palmar hyperhidrosis should undergo a postoperative satisfaction survey (as per the Department of Health's correspondence)?

Currently, the methods for treating palmar hyperhidrosis, such as cauterizing or cutting the second or third sympathetic nerve trunk in the back, which result in a 40-50% reduction in sweating or significantly less sweating, are highly misguided.
There are two serious complications associated with these procedures:
1.
It can lead to anhidrosis of the upper body, causing excessive heat in that area.
The inability to sweat and dissipate heat, especially on the head during summer walks, can result in near-heatstroke conditions, leaving the head feeling extremely hot and uncomfortable.
This situation is akin to a computer CPU requiring a fan and heat sink for cooling; otherwise, it risks overheating.
This complication is often overlooked by physicians, who may not be aware of it, or they may fear that informing patients will deter them from undergoing surgery.
As a result, there are no available surgical options for hyperhidrosis.
The question arises: how can one remain calm or exercise when the head is persistently hot?
2.
There is also severe compensatory sweating in the lower body, leading to excessive perspiration as if one were submerged in water, resulting in a constant damp feeling.
This approach is similar to addressing flooding in Xizhi by preventing rain in areas north of Hsinchu, causing all rainfall to occur south of Hsinchu.
While the flooding in Xizhi may be resolved, the northern regions will suffer from drought, and the southern regions will face continuous flooding.
The correct approach should involve anatomical intervention at the wrist, where the sympathetic nerves affecting the palm can be "clamped," achieving the desired reduction in sweating without cutting or cauterizing, which is difficult to reverse.
Destroying the sympathetic nerves can lead to disorganized nerve regeneration, potentially resulting in the growth of neuromas.
Other areas that should normally sweat will maintain their function, and compensatory sweating will not be as severe.
However, currently, no doctors are willing to explore the sympathetic nerves affecting the palm, leaving patients to suffer further.
To locate the sympathetic nerves affecting the palm and wrist, a pulse wave detection method can be employed, allowing for quick identification.
Once located, these sympathetic nerves can be "clamped," resulting in a reduction of sweating limited to the palm (1-2%), and even if compensatory sweating occurs, it would only be (1-2%).
This method is safe, requiring only local anesthesia without serious complications.

Currently, it is essential to conduct satisfaction surveys post-surgery for palmar hyperhidrosis.
If the condition worsens after surgery compared to before, is it truly worth spending money and enduring a procedure that results in complications more severe than the original hyperhidrosis?

Lü, 30~39 year old female. Ask Date: 2003/12/25

Dr. Yang Hongzhi reply Internal Medicine

Hello:
1.
A second or third thoracic sympathetic nerve ablation surgery will not cause anhidrosis of the head, unless the first thoracic sympathetic nerve is affected during the procedure, which could lead to such a complication.

2.
Compensatory hyperhidrosis occurs in about 50% of cases and can cause discomfort for some patients.
It is important to fully inform patients about this potential complication before surgery.
However, the ability to reduce sweating can have significant positive implications for work and social interactions, and most patients can accept this side effect.

3.
The peripheral nerves in the palm include sympathetic and parasympathetic nerves, as well as sensory and motor nerves.
Under microscopic examination or nerve function tests, it is not possible to distinguish between them.
During surgery, it is not feasible to selectively clamp only the sympathetic nerve fibers without affecting other nerves.
Conversely, at the source of the sympathetic nerves, specifically the sympathetic ganglia located on either side of the spine, it is possible to selectively destroy the sympathetic nerves without damaging other nerves.
This is the surgical site with the least complications and side effects.

Neurosurgery Director, Zheng Zhong

Reply Date: 2003/12/25

More Info

Hyperhidrosis, or excessive sweating, can significantly impact a person's quality of life, leading many to seek surgical interventions as a solution. However, the surgical options available, particularly those involving the sympathetic nervous system, come with their own set of risks and potential complications that patients should be aware of before proceeding.

One common surgical approach is the interruption of the sympathetic nerves that control sweating in the hands, which can be achieved through procedures such as sympathectomy. While this can effectively reduce sweating in the targeted areas, it is essential to understand the potential side effects that may arise from such interventions.
One of the most concerning complications is compensatory sweating, where patients experience increased sweating in other areas of the body, often in the lower body. This phenomenon can lead to discomfort and dissatisfaction with the surgical outcome, as patients may find themselves dealing with excessive sweating in areas they previously did not have issues with. In some cases, this compensatory sweating can be more severe than the original condition, leading to a situation where the patient feels worse off than before the surgery.

Another significant risk associated with sympathectomy is the potential for anhidrosis, or the inability to sweat in the upper body. This can lead to overheating, especially in warmer climates or during physical activity, as the body loses its natural cooling mechanism. Patients may find themselves feeling excessively hot, particularly in the head and upper torso, which can be uncomfortable and even dangerous in extreme conditions. The analogy of a computer overheating without proper cooling is apt here; just as a computer requires a fan to dissipate heat, the human body relies on sweating to regulate temperature.

Moreover, the surgical approach to treating hyperhidrosis often involves general anesthesia, which carries its own risks, particularly for patients with underlying health conditions. The need for a thorough preoperative assessment is crucial to ensure that the patient is a suitable candidate for surgery.

Given these potential complications, it is vital for patients to engage in thorough discussions with their healthcare providers about the risks and benefits of hyperhidrosis surgery. This includes understanding the likelihood of experiencing compensatory sweating or anhidrosis and the impact these may have on their daily lives.
Additionally, the idea of conducting patient satisfaction surveys post-surgery is an excellent suggestion. Such surveys can provide valuable insights into the real-world outcomes of hyperhidrosis surgeries, helping to identify how many patients experience complications and how they feel about the results of their procedures. This feedback can be instrumental in refining surgical techniques and improving patient education regarding the potential risks and benefits.

In conclusion, while surgery for hyperhidrosis can offer relief for some patients, it is essential to weigh the potential benefits against the risks of significant side effects. Patients should be well-informed and consider all options, including non-surgical treatments, before making a decision. Engaging in open dialogue with healthcare providers and considering the experiences of others through satisfaction surveys can help guide this decision-making process. Ultimately, the goal should be to achieve a balance between managing hyperhidrosis effectively while minimizing the risk of adverse outcomes that could lead to greater discomfort.

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