Thoracic sympathectomy (excessive sweating of the hands)

Hyperhidrosis is excessive sweating with no underlying medical cause, mainly affecting the hands, sometimes the armpits and the face. It can be very disruptive in daily life: shaking hands, writing, using a touchscreen or a tool. Thoracic sympathectomy interrupts the nerve chain that controls sweating of the hands. The operation is performed under general anaesthesia, by thoracoscopy: one or two very small incisions under the armpit, on each side, allow a camera and fine instruments to be introduced. The surgeon locates the sympathetic chain running along the spine, inside the chest, and divides it, coagulates it or blocks it with a small clip at a precise level. Both sides are usually treated during the same anaesthetic. It is offered when sweating of the hands remains very troublesome despite the usual treatments: strong antiperspirants, iontophoresis, medication. The patient must be well informed before making a decision, in particular about the risk of compensatory sweating in other parts of the body. At Clinique Pasteur Tunis, thoracic sympathectomy is performed in the operating theatre by thoracic surgeons, with a video-surgery system, usually with a single night in hospital.