Sympathectomy - Surgery to cure sweaty palms


Patients face the risk of developing a drooping eyelid if an adjacent nerve is accidentally damaged during surgery. However, the condition, known as Horner Syndrome, isn’t as big a concern as before because different surgical techniques are used today.

“This risk was significant in the past. But, with the advent of keyhole surgery, precise techniques that reduce this risk significantly are now available,” said Associate Professor Peter Mack, Senior Consultant, Department of Hepato-pancreato-biliary and Transplant Surgery, Singapore General Hospital (SGH), a member of the SingHealth group​. The equipment used in keyhole surgery provides very good illumination and magnification, making it easier to identify organs and nerves inside a patient’s body accurately, he added.

A more common complication is compen​satory sweating, which causes a patient to experience heavy perspiration in another area of the body after sympathectomy. Almost all patients experience some compensatory sweating after the procedure, said A​​/Prof Mack​​. “For some patients, it’s negligible. But, for others, it can be quite significant.”

Ms Tan’s palms stopped sweating immediately after her surgery and were “completely dry”. However, she suffers from compensatory sweating. Whenever she exercises or if the weather is hot, her chest becomes wet with perspiration. But she can live with this inconvenience as she no longer has to worry about the embarrassment of a hand dripping with sweat.

“Now, I’m not worried about my hand getting wet at any minute. If I touch someone, I don’t have to be afraid that the person won’t like it,” she said.

How sympathectomy works

The procedure refers to the surgical destruction of the nerves responsible for excessive sweating. These nerves are located within the chest. The patient undergoes “single-lung anaesthesia”, which means that one of his lungs will be collapsed during the operation. Collapsing the lung provides access to the nerves that will be operated on, said A/Prof Mack.

A keyhole incision is made under the armpit, through which an endoscope is inserted into one side of the chest. This provides access to the nerves to be operated on. A current is passed through to destroy the nerves. The patient’s palms will become dry and warm within minutes after the procedure. The collapsed lung is then inflated and the keyhole wound is stitched up.

The process is repeated on the other side of the chest.

The operation takes about 1½ hours, after which the patient stays overnight at the hospital. Most patients can go home the following day if the results of a post-operation x-ray are satisfactory, said A/Prof Mack. After the operation, the patient may feel a mild ache in the centre of the chest, but this should fade after a few days. The stitches are removed after one week and patients usually feel well by then.

Ref. S13