If the patient sweats a lot on the feet, can it be improved by this surgery?
Dr. Liu Yanguo: Hand sweating is often combined with foot sweating, but the surgery can only solve the hand sweating, only 30% of patients will have a slight reduction in foot sweating after surgery, which means that most patients do not have a good reduction in foot sweating.
If a patient has more sweating in the armpit or has fox odor, can the sweating in the armpit also be reduced through surgery?
Dr. Liu Yanguo: Axillary sweating can be improved, but axillary odor is not suitable for this surgery, the effect is not good.
Will the sweating in other parts of the body be reduced after the surgery?
Dr. Liu Yanguo: The main problem is hand sweating, which has no effect on other parts of the body.
Some patients report that they suddenly have a lot of sweaty palms a week or so after the surgery.
Dr. Liu Yanguo: There is such a phenomenon – some patients have good post-operative results and suddenly have sweaty palms a week or so after surgery, which is a transient sweating after surgery. This usually lasts for about 2 or 3 days or a week, and after that time, it stops. It is a physiological reaction.
Can surgery cause drooping eyelids?
Dr. Liu Yanguo: At the early stage decades ago, the sympathetic nerve anatomy was not well understood, so the old surgery cut the nerve at a high position, which might damage the stellate ganglion and cause Horner’s syndrome, the prominent manifestation of which is eyelid drooping, in addition to facial sweating, pupil narrowing, and eye sunken. Nowadays, the T3 or T4 segment is chosen as the location of the cut, which is not at the same location as the stellate ganglion, so the probability of injury is almost zero, and it is impossible for the eyelid to droop.
Does this surgery involve cutting all the sympathetic nerves in the chest?
Dr. Liu Yanguo: No, of course not. The sympathetic nerve is cut at the small stage that governs the sweating of the palm.
What is the difference between T3 and T4 sympathetic nerve block?
Dr. Liu Yanguo: Both T3 and T4 sympathetic nerve block are the mainstay of hand sweating treatment, and both methods are available. After T3 cut, the patient’s hands will be drier and the treatment of hand sweating will be more complete, but it also has more side effects, the so-called side effects refer to the compensatory body sweating is heavier; after T4 cut, some of the patients’ hands will be a little bit damp and not so dry, but the advantage is that the side effects are less – the body sweating is heavier. But the advantage is that the side effects are less – the compensatory sweating of the body is very light.
Do you generally recommend T3 or T4 block?
Dr. Liu Yanguo: First of all, I will explain the pros and cons of the two procedures to the patient and let the patient choose according to his preference (T3 block if he wants to be drier, T4 cut if he is worried about too much compensatory sweating); in addition, I will also make an individualized assessment of the patient with reference to the severity of sweating on the hands to determine which procedure is suitable for the patient.
If the sympathetic nerve is cut, will there be any adverse effects?
Dr. Liu Yanguo: The surgeon has a very good grasp of the location and extent of the nerve cut, and the sympathetic nerves in other areas will not be affected. The targeting of the surgery is very clear – it is only the sweating of the hand, which has little effect on the body. The experience of the surgeon is important.
Some patients report that sweating in the hands is less after surgery, but sweating in other areas, why is that?
Dr. Liu Yanguo: This is a side effect of the surgery – “compensatory sweating”, which means that after the hand sweating is reduced, sweating increases in the trunk area, especially in the front and back.
Can compensatory sweating be corrected?
Dr. Liu Yanguo: Once compensatory sweating occurs, it usually does not reduce naturally, so the only way to prevent or avoid it is to find ways to prevent it.
What do you think should be done to avoid compensatory sweating?
Dr. Liu Yanguo: The main factor related to compensatory sweating is the way the surgery is performed – the location of the sympathetic nerve cut. Traditionally, compensatory sweating is very heavy after surgery, but in the last decade or so, through repeated improvements in the surgical approach, the existing surgical approach can minimize or basically avoid compensatory sweating. Although some patients also experience increased sweating in the trunk area after surgery, it has little impact on daily life.
If a patient is unfortunate enough to have postoperative compensatory sweating, how should it be managed?
Dr. Liu Yanguo: I have had many patients ask me this question online. Most of these cases are caused by the previous surgical procedure, and the patient has to adapt to it again; also, as I mentioned earlier, as people age, their overall sweating volume decreases, and as the overall sweating volume decreases, compensatory sweating will gradually become less of a problem.
Is there no particular way to deal with compensatory sweating?
Dr. Liu Yanguo: So far, there is no treatment method.
Do you have to cut all the sympathetic nerves in the chest for this surgery?
Dr. Yanguo Liu: No, of course not. The sympathetic nerve must be the one that governs the small phase of sweating in the palm.
If the sympathetic nerve is cut, will there be any adverse effects?
Dr. Liu Yanguo: The doctor has a very good grasp of the location and scope of the nerve cut, and the sympathetic nerves in other parts of the body will not be affected, so the surgery is clearly targeted – only the sweating of the hand, which has little effect on the body.
What should I pay attention to after the surgery in terms of patient care, exercise and diet?
Dr. Liu Yanguo: Patients should be careful not to get water in the axillary wound and not to get infected. This surgery is relatively short, for example, the surgery is done on Friday, discharged on Saturday, rest on Sunday, and then you can go to work on Monday. There are no special contraindications in terms of diet and exercise.
Is there any recurrence of hand sweating in patients after surgery?
Dr. Liu Yanguo: There is a recurrence rate of about 5% for individual patients.
What should I do after the recurrence?
Dr. Liu Yanguo: It depends on the specific situation. Generally, the symptoms of recurrence after surgery are less severe than before surgery, so if the patient feels that life is okay and the impact is not that great, you can leave it alone; if the patient feels that the symptoms are very heavy, or even back to the state before surgery, then you can also consider another surgery.
How long is the hospital stay for hand sweating surgery?
Dr. Liu Yanguo: The hospital stay is like this: the first day of the hospital stay is for some tests, the second day is for the surgery, the surgery is observed for one night and then discharged, actually three days.
What is the approximate cost of the surgery?
Dr. Liu Yanguo: At present, the total cost in our unit (Thoracic Surgery Department of Peking University People’s Hospital) is about 10,000 yuan.
What should I pay attention to after the operation in terms of patient care, exercise and diet?
Dr. Yanguo Liu: Patients should pay attention to not getting water in the axillary wound and not to get infected. This surgery is relatively short, for example, the surgery is done on Friday, discharged on Saturday, rest on Sunday, and then you can go to work on Monday. There are no special contraindications in terms of diet and exercise.
Is there any recurrence of hand sweating in patients after surgery?
Dr. Liu Yanguo: There is a recurrence rate of about 5% for individual patients.
What should I do after the recurrence?
Dr. Liu Yanguo: It depends on the specific situation. Generally, the symptoms of recurrence after surgery are less severe than before surgery, so if the patient feels that life is okay and the impact is not that great, then it can be left alone; if the patient feels that the symptoms are very heavy and even return to the state before surgery, then you can also consider another surgery.