Sympathectomy (Endoscopic Thoracic Sympathectomy or ETS)
The principle of sympathectomy is to interrupt the nerve tracks and nodes (ganglia) which transmit the signals to the sweat glands.Today, the treatment of choice for moderate to severe palmar and facial hyperhidrosis (also axillary, especially if combined with palmar sweating), is a surgical procedure known as Endoscopic Thoracic Sympathectomy.

This minimal-invasive endoscopic technique has been developed in recent years, superseeding Conventional Thoracic Sympathectomy, a very traumatic procedure performed in the past. The endoscopic technique is generally safe, if performed by a surgeon experienced in this type of procedure, and leads to definitive cure in nearly 90% of patients, leaving only a minimal scar in the armpit.

Individuals with combined hyperhidrosis of the palms and soles of the feet stands a good chance of curing their problem. Sometimes sweating of their feet also minimised after an operation aimed to suppress sweating of the hands. Isolated plantar hyperhidrosis can, however only cured by Lumbar Sympathectomy, an open abdominal procedure.

Diffuse hyperhidrosis of the trunk or general sweating of the whole body cannot be treated by surgery.

-Immediate effect
-Extremely effective for palmar hyperhidrosis
-Permanent (most of the cases)
-Tolerable side effects for most of the people
-Quick recovery time. Can go back to work within few days
-Extremely small scars under the armpits

-Expensive, it costs around RM10,000 (~USD2400) to have this surgery in Malaysia
-Compensatory sweating (CS) will occur in other places like trunk, thighs and other places.
-Horners Syndrome may occur. In patients who experience Horners Syndrome, the eyelid appears to droop slightly
-Gustatory sweating is a relatively rare side effect of sympathectomy. Patients who experience this will notice increased sweating when eating certain food or from the smell of certain food.
-Sweating will reoccur after the surgery. There is a chance that the cut nerves regrow after the surgery
-Clips (if used) could be made of metal. Having metal in your body might cause problems in near future especially during X-Ray, MRI or passing through immigration check. Please clarify with your surgeon on type of metal is being used and its effects.

There is no surgery which is 100% effective. So you should bear in mind that there will be risks of things going wrong during the surgery. Pray hard and get yourself an experienced surgeon to do this surgery.