Surgical Options for Hyperhidrosis: Insights and Costs - Neurosurgery

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Hyperhidrosis, or excessive sweating, can be a challenging condition for many individuals, particularly when it affects the hands and underarms. Surgical options are available for those who have not found relief through conservative treatments. One of the most commonly discussed surgical procedures for hyperhidrosis is endoscopic thoracic sympathectomy (ETS), which involves cutting the sympathetic nerves that control sweating in specific areas of the body.


Understanding Endoscopic Thoracic Sympathectomy (ETS)
ETS is indeed the procedure you are referring to when you mention the possibility of reconnecting nerves if the surgery does not yield the desired results. During the procedure, the surgeon makes small incisions in the chest and uses an endoscope to visualize and cut the sympathetic nerves responsible for sweating in the hands and underarms. While ETS can significantly reduce sweating in these areas, it is important to note that it may lead to compensatory sweating in other areas of the body, such as the back or legs, as the body attempts to maintain its thermoregulation.


Surgical Options for Hand and Underarm Sweating
If you are considering surgery for both hand and underarm sweating, it is essential to discuss your specific symptoms with your surgeon. ETS typically addresses both areas simultaneously, but some surgeons may recommend separate procedures depending on the severity and location of your hyperhidrosis.

Risks and Considerations
While ETS can be effective, it is not without risks. Potential complications include:
- Compensatory Sweating: As mentioned, this is the most common side effect, where sweating increases in other areas of the body.

- Pneumothorax: A collapsed lung can occur during the procedure, requiring additional treatment.

- Horner's Syndrome: This rare complication can result in drooping eyelids and constricted pupils on one side of the face.

- Nerve Regeneration: Although the nerves can sometimes be reconnected, the success of this procedure varies, and it may not restore normal sweating.


Costs of Surgery
The cost of ETS can vary significantly based on geographic location, the surgeon's experience, and the facility where the surgery is performed. In the United States, the cost can range from $5,000 to $15,000 or more, depending on whether the procedure is done in an outpatient or inpatient setting. Insurance coverage may vary, so it is advisable to check with your provider regarding coverage for hyperhidrosis surgery.


Conclusion
If you are considering surgery for hyperhidrosis, it is crucial to have a thorough discussion with a qualified surgeon who specializes in this area. They can provide insights into the best surgical options for your specific condition, the potential risks and benefits, and the expected costs. Additionally, exploring non-surgical options such as Botox injections, iontophoresis, or prescription antiperspirants may also be worthwhile before committing to surgery. Ultimately, the decision should be based on a comprehensive evaluation of your symptoms, lifestyle, and personal preferences.