Hyperhidrosis (excessive sweating) is a serious medical condition in which the body’s cooling mechanism is overactive.

For people with hyperhidrosis, sweating can be embarrassing, uncomfortable and an impediment to daily activities. Stress, emotion and exercise can trigger the sweating, but it also can occur spontaneously. Patients with palmar hyperhidrosis have wet or moist hands, which can interfere with grasping objects and make shaking hands a difficult social problem. Those who suffer from axillary hyperhidrosis sweat excessively from their underarms and find their clothing stained shortly after they dress. Plantar hyperhidrosis causes profuse sweating in the feet, moistens socks and shoes, and can lead to increased foot odor.

According to the Society of Thoracic Surgeons, hyperhidrosis affects about one percent of the population.


Treatment usually begins with medical remedies, which do not involve surgery. These treatments include astringent ointments and salve, electrical stimulation and medications. If medical treatments fail, some positive results have been reported with local injections to block the sweating nerves.

Generally, surgery is considered only after less invasive treatments have failed to relieve symptoms. Washington University thoracic surgeons offer a surgical center for St. Louis area patients with hyperhidrosis who have tried other treatments unsuccessfully. They perform a VATS (video-assisted thoracic surgery) sympathectomy, a minimally invasive operation in which a specific portion of the main sympathetic (sweating) nerve is removed. The operation, which removes about three to four inches of nerves that control the sweat glands, doesn’t affect the patient’s muscle function or sensation but greatly reduces sweating in the hands and/or the armpits.

The operation is performed on both sides and generally takes about an hour. Patients usually are discharged the same day.

Potential complications

The most common potential side effect of the VATS sympathectomy is compensatory sweating, which occurs in up to 60 percent of patients. Although the operation prevents sweating in the hands and/or the armpits, it is possible that patients will notice more sweating on their backs, legs and other regions of their bodies. This compensates for lack of sweating in the upper extremities. Most patients, even those who have compensatory sweating, report satisfaction with the results of this surgery.

As with any surgery, there are other risks that include reaction to anesthetic agents or drugs and infection at the site of the operation.

Thoracic surgeons

Contact us

For an appointment with a thoracic surgeon, call 888-287-8741 or 314-362-7260.

More about hyperhidrosis