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THORACOSCOPIC
SYMPATHECTOMY FOR SWEATY PALMS
1. When
is surgery needed for sweaty
palms?
Excessively
sweaty palms are usually no
more than a nuisance. Occasionally,
however, they may cause social
embarrassment or interference
with sports or occupation. Medical
treatment with dermatological
agents and iontophoresis sometimes
work and this should be attempted.
Those who fail conservative
treatment and are incapacitated
with the problem may consider
surgery for a permanent cure.
2. What
operation can be done?
A procedure
called Thoracoscopic Sympathectomy
can be done. The main principle
of the operation is to divide
the sympathetic nerves which
control sweating in the palms.
The nerves are found in the
thoracic cavity running along
the neck of the ribs. A complete
division of the nerves from
the second to the fourth rib
is usually recommended. Those
patients with excessive sweating
in the armpits may require a
modification of the levels divided.
The entire
operation can be performed with
the keyhole technique called
Thoracoscopy. A 5 mm telescope
is used to visualization. Two
3 mm instruments are used to
locate, dissect and divide the
sympathetic nerves.
3. What
can I expect before and after
surgery?
Some surgeons
do this procedure on one side
first and delay the procedure
on the other side till a few
weeks later. We prefer to do
both sides at the same time
if the patient is young and
fit. This obviates the need
for two separate operations.
The operation
is done under General Anaesthesia.
Patients are usually admitted
to hospital on the day of surgery
and stay overnight for observation.
A small chest tube is sometimes
left inside the rib cage for
a few hours after the surgery
is completed. This can be removed
once the lung is fully re-expanded.
Recovery is
usually rapid as only small
keyhole incisions are used.
Occasionally, however, you may
feel some pain for the first
few weeks. This can sometimes
be intermittently severe. There
may also be a feeling of heaviness
in the chest and pain in the
arms for a few days. Temporary
recurrence of the sweaty palms,
lasting for a few hours, may
happen especially between the
second and fifth day after surgery.
Most patients
are completely satisfied with
the results of surgery. They
can, however, have compensatory
excessive sweating in the trunk
due to a rebound phenomenon.
This is usually of little concern
but do remember that it can
happen and it cannot be prevented.
Surgery is also irreversible
once it is done so do reconsider
whether you want to have the
operation if you feel that this
side effect is going to bother
you.
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