Excessive Foot sweating is almost always accompanied by excessive hand sweating. Even though foot sweating does not have the social significance like hands do it still poses a severe impact both socially and physiologically for those who suffer from excessive foot sweating. The notion that ETS can help with excessive foot sweating (plantar hyperhidrosis) faded as more experience was gained since 1990. For many years ETS was the procedure performed by most surgeons to eliminate hand sweating with the hope it would also help with excessive foot sweating. This was not the case and most of the patients, after ETS, still had excessive foot sweating. The medical community then discovered that lumbar sympathectomy was the best and most effective surgical treatment for excessive foot sweating with a much higher degree of success (98%). In a higher percentage of patients the severity of plantar hyperhidrosis (foot sweating) is not being manifested in the early to late teens like is the case with palmar hyperhidrosis (hand sweating). The physiological explanation for that is the fact that the maturation of the sweat glands in the feet occurs slightly later in life.
Basically with this procedure the lumbar sympathetic chain is approached endoscopically through small cuts in the side of the abdomen. The sympathetic chain in the lumbar region is exposed and clamped or divided as per the surgeons choice.
Effectiveness of Sweaty Feet treatment:
The success rate is about 97% to 98% and the operation can be accomplished on an outpatient (return home the same day) basis with a low amount of pain. A return to normal life can also be obtained within a short time (2-3 days). Most of the patients who had Endoscopic Thoracic Sympathectomy as well as Endoscopic Lumbar Sympathectomy claim that the amount of pain after Endoscopic Lumbar Sympathectomy is less than the pain from Thoracic Sympathectomy. The ELS procedure is done through three relatively small cuts on each side of the abdominal cavity. With this lateral approach the abdominal cavity is not entered. Also the clamping method that is being used, enables exact verification where the lumbar sympathectomy was done. It is very important to stay below the level of the second lumbar vertebra.
In about 10% of the cases patients may experience a short lived recurrence which occurs about 3 ½ days after the operation. This is only temporary and will go away, as long as the first 3 ½ days were totally dry. A true recurrence which means the operation was not successful, will become within a few hours to a day after the operation. Success rates are high however there is a small possibility of recurrence. So far no reversal surgeries have been done.
Endoscopic Thoracic Sympathectomy (ETS) and Endoscopic Lumbar Sympathectomy (ELS):
Even though both ETS and ELS are very effective in treating palmar and plantar hyperhidrosis cannot be performed at the same time. At present Dr. Reisfeld recommends patients wait at least 4 months between ETS and ELS. Which procedure is done first really depends on the patients preference. So far the majority of patients that can benefit from both procedures choose ETS first but the reverse can be done as well. Over time an interesting finding has emerged. Patients with mild palmar hyperhidrosis (sweaty hands) but with severe plantar hyperhidrosis (sweaty feet) who have the ELS procedure done may experience an increase in their palmar hyperhidrosis. The level of which and length of time that this occurs is to yet to be determined. It may be that these patients could benefit from ETS as well but it is still too early to tell.
Another observation that came about is the fact that patients who have groin and buttocks compensatory sweating after the ETS procedure get some improvement with their excessive compensatory sweating of those sites when the level of the ELS is kept at L2 or as close to L2 as possible. This observation will need many more cases to confirm in the future but so far it’s an encouraging finding.
Dr. Reisfeld Publishes Important Paper
As more experience has been gained Dr. Reisfeld published two peer reviewed papers with regard to this subject. Again it showed that lumbar sympathectomy for the treatment of severe plantar hyperhidrosis (foot sweating) can be accomplished but it should be done by highly experienced and knowledgeable surgeons. There are some very delicate technical aspects to the surgery and also the level of the lumbar sympathectomy is important. If a patient had a previous thoracic sympathectomy the level of compensatory sweating which came after the ETS will stay basically the same. Again it was proven that patients tolerate the procedure well and the amount of discomfort/side effects are kept to a minimum.
Dr. Reisfeld published a paper detailing the treatment and the success rate via lumbar sympathectomy for patients who suffer from plantar hyperhidrosis (feet sweating). In his paper he demonstrates that with lumbar sympathectomy feet sweating is eliminated with a success rate of about 96 to 97%.
Lumbar sympathectomy for excessive foot sweating is a very viable option. Again this should be discussed with an experienced surgeon after local conservative methods have been tried and failed.
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