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Hyperhidrosis Info
hyperhidrosis Naturale Clinic I - São Paulo
Av. Moema , 87 cj 51-52
Moema – São Paulo
Parking : Al. dos Jurupis 452
phone: 55 11 50511075
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Avenida Antonio Ometto, 525
Limeira – São Paulo
Phone 55 19 34538490
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Video Endoscopic Sympathectomy

The videoendoscopic Sympathectomy is performed under general anesthesia. A stem is introduced through a small cut in the thorax. With the aid of the video, the surgeon identifies the sympathetic nerve. Through a cautery, the responsible nerves for Hyperhidrosis are destroyed. The technique is efficient, with excellent results. But it presents complications, among them, the most frequent one is the Compensatory Hyperhidrosis (a sweating increase in other parts of the body), that it is a very unpleasant situation.
The surgical treatment of Hyperhidrosis, the Sympathectomy, involves the removal of a specific part of the main sympathetic nerve. It is well knon that the sympathetic nerves are part of a separate and parallel nervous system. The anatomical position and the function is separate from the somatic nerve system(volunteer), which are the nerves that control the sensations and the movements. The "chain" of sympathetic nerves is formed by a group of nerves located close to the ribs in the thorax. They are very close to the spine. The nervous branches, that leave the ganglions, reach the gland and stimulate the sweating. There is a ganglion in each vertebral level of the spine and all these ganglions are attached one to another longitudinally forming the "sympathetic chain". The branches of the sympathetic nerve come off each one of these ganglions and they will act on the blood vessels and sweating glands in the body. The surgical therapy for Hyperhidrosis requests the removal and destruction of this specific ganglion that cause the sweating of the hands and armpit. There is a variety of manners of working with the sympathetic ganglions: removing, cauterizing, or cutting the branches. All of these techniques are capable to block Hyperhidrosis.
In the classic technique to treat Palmar Hyperhidrosis (hands), the ganglion of T2 is moved away or destroyed. Many surgeons will also remove the third ganglion to maximize the chance to stop the sweating of the hands completely. To treat the armpit, the second and third ganglion is moved away or destroyed. Just the same, some surgeons will also destroy the fourth ganglion to maximize the result. To reduce the possibility of Compensatory Hyperhidrosis, the ganglions are being more selectively chosen. But this does not guarantee that compensatory Hyperhidrosis won't happen and it increases the chances of reoccurance of Hyperhidrosis.
In the past, an incision of larger size was used in the thorax or in the lateral of the neck. That demanded cuts with scars to expose the sympathetic chain. However, recent progresses in technology produced less invasive methods, such as the videoendoscopic Sympathectomy. This requests general anesthesia for the patient. Once asleep, two or three small holes (5-10 mm) are performed in the thorax. Through these holes, an endoscope with a video camera sends images to the doctor. With this technique, the sympathetic chain can be identified. Through the incisions, instruments are intrduced to allow the surgeon to remove and destroy the specific ganglions, depending on the patient's symptoms. To perform this operation, the patient's lung has to be collapsed to allow appropriate space for the surgeon to maneuver. After the conclusion of the operation, the lung is refilled and the incisions are closed. Occasionally, a small tube is maintained inside the thorax to allow evacuation of air, however, that is removed some hours after the surgery. After a side is completed, the surgeon repeats the procedure on the opposite side
Usually, the patients leave the hospital in a period of 24 hours following the surgery. There is some post-operative pain, which requires medication for some days.

Naturale Clinic’s Treatment

Many patients can benefit from the Sympathectomy, but some few ones can not. As the problems resulting from the surgery are unexpected and do not depend on the doctor who performs the surgery, we prefer to treat Hyperhidrosis with the Botulinum Toxin (BOTOX® / Dysport) because it does not cause neither Compensatory Hyperhidrosis nor Syndrome of Horner, and there are no surgical complications.
If the choice is safety, the best option is the Botulinum Toxin (BOTOX® / Dysport) injection. If the choice is the fact of being definitive, the best option is Sympathectomy, in spite of its important risks and possible complications.

Considerando a ausência de risco e complicações e facilidade do procedimento, preferimos a Toxina Botulínica ( BOTOX® / Dysport ) à Simpatectomia em nossa Clínica.



Existem 2 técnicas eficientes para tratar a Hiper-hidrose:

A Toxina Botulínica

A Simpatectomia

A Toxina Botulínica, que preferimos, tem poucos riscos, mas não é definitiva, a simpatectomia é definitiva, mas tem maiores riscos e complicações.

Assim, como as duas técnicas são diferentes, e ambas são eficientes, o médico deve explicar ao paciente as vantagens e desvantagens de cada técnica e a escolha deve ser opção do médico e do paciente



A Simpatectomia

A principal vantagem da Simpatectomia, é de que é um procedimento definitivo.

As desvantagens são os riscos de uma cirurgia, a Hiper-hidrose compensatória, a Síndrome de Horner, O Pneumotórax, o Hemotórax, a assimetria de resultados, resultados imcompletos, complicações anestésicas, necessidade de internação hospitalar, anestesia geral, não é reversível, é uma técnica de maior complexidade, e utiliza material complexo.

A Toxina Botulínica

A principal desvantagem da Toxina Botulínica é de que não é um procedimento definitivo, tem um custo relativamente elevado por não ser definitiva, e apresenta um pequeno índice de falhas.

As principais vantagens são: É um procedimento ambulatorial, que não necessita internação, é reversível, é simples, o material é simples, a técnica tem baixo risco, não provoca Hiper-hidrose compensatória, não tem síndrome de Horner, não tem complicações cirúrgicas, é realizada sob anestesia local, no consultório.



Na Clínica Naturale , preferimos a Toxina Botulínica porque é um tratamento simples, para um problema simples.


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