Sweating Disorder Treatable With Surgery March 7, 2007

We all know people who perspire a lot, especially in ultra-warm Central Texas. A small minority, however, suffer so extensively that it creates virtual social ostracism. Many are reclusive and can't work, have few social relationships and most have tried everything medically possible to control the condition to no avail. They have a syndrome called hyperhidrosis that results in profuse sweating on the palms, soles, underarms, chest and back for no apparent reason. It impacts about 200,000 Americans.

Physicians have known for about 50 years that the condition often can be controlled by surgically disconnecting part of the sympathetic nervous system. The surgery was rarely performed because the nerves involved run deep inside the chest cavity. It required an open chest procedure by a skilled cardiothoracic surgeon similar to open heart surgery, making the cure far more risky than the condition itself justified. That has changed due to the development of new tools and techniques allowing surgeons to access the nerve through a tiny incision and insertion of a catheter that allows the surgeon to visualize the interior of the chest and the tissues it contains.

William F. Kessler, M.D., a cardiothoracic surgeon,and his colleagues, Andrew T. Hume, M.D., and John D. Oswalt, M.D. with Cardiothoracic and Vascular Surgeons (CTVS) , are part of a small number of Central Texas doctors performing this minimally invasive surgery called thorascopic sympethectomy.

"This surgery can change someone's life," says Dr. Kessler. "People who were formerly reclusive, embarrassed, afraid to shake hands and suffering from social stigma have experienced such significant improvement that they often move onto new jobs, form new relationships and for the first time in their lives can live normally. Many people don't even know this solution exists."

Dr. Kessler is a subspecialist who rarely sees patients who have not been referred through a medical chain that includes their primary care doctor and a cardiologist. He most often handles complex heart surgeries and is highly regarded in connection with his work on vascular assist device technology (VAD). VADs connect patients to small briefcase-sized machines that support their hearts while they are waiting for a transplant or for their own heart to recover from a life-threatening illness.

He gets direct calls, however, from potential sympathectomy patients who have heard about him and the procedure from other sufferers. That's okay with him.

"There's not a good way to let people know this surgery is available and how effective it can be. The procedure is performed on an out-patient basis, although occasionally a patient has to remain in the hospital overnight. Video-assisted thoroscopic surgery is evolving quickly and improving the tools we have to use," he adds.

During the procedure, Dr. Kessler enters the chest cavity though small incisions under the armpits. A tiny camera device inside a catheter allows him to see the chest structures and identify the location of the nerve. Using the catheter, the nerve is snipped and the ends cauterized. The catheter is then removed and the incisions closed with a couple of stitches. For most patients, the results are immediate. They wake up, sometimes for the first time in years, with warm and dry hands and feet. There are a few patients for whom the procedure does not correct their problem and occasional side effects that would be explained to potential patients.

Dr. Kessler enjoys working with hyperhidrosis sufferers. "This is the least invasive procedure I perform but the rewards for the patient are dramatic. It really improves their quality of life."

William F. Kessler, M.D.

Originally from Houston, Dr. Kessler received his medical degree from Baylor College of Medicine in Houston and completed his General Surgery and Cardiothoracic Surgery residencies at the University of Texas Southwestern Medical Center in Dallas. Further training included a fellowship in Heart Transplantation at the University of California, Los Angeles. Dr. Kessler is a Fellow of the American College of surgeons and a Diplomate of the American Board of Surgery and the American Board of Thoracic Surgery. He specializes in adult Cardiothoracic Surgery including heart transplantation, implantation and management of ventricular assist devices (VADS), valvular heart disease and all areas of Thoracic Surgery. Dr. Kessler has participated in numerous research studies and has authored various research articles in his specialty.

...