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Hyperhidrosis Surgical Treatment Options


Dr. Reisfeld Performing Surgery
Dr. Reisfeld, one of the worlds top hyperhidrosis surgeons.

This page describes the most effective types of surgery depending on the location and severity of a patient's hyperhidrosis. Dr. Reisfeld is the only known surgeon in the world to be an expert at all three major procedures listed below. This gives him unparalled expertise in performing these procedures. To learn more see and click the four major types below:

  1. For those who suffer primarily from severe and excessive hand sweating (palmar hyperhidrosis) then endoscopic thoracic sympathectomy is most appropriate.
    Learn more about Endoscopic Thoracic Sympathectomy (ETS)


  2. For those who suffer from severe excessive foot sweating (plantar hyperhidrosis) as their primary or only area of excessive sweating or for those patients who did not get any benefit from endoscopic thoracic sympathectomy for their foot sweating then endoscopic lumbar sympathectomy is an appropriate procedure.
    Learn more about Endoscopic Lumbar Sympathectomy (ELS)


  3. For those patients suffering from excessive armpit sweating (axillary hyperhidrosis) the current method is a combination of subdermal laser ablation of sweat glands and as well as axillary suction currettage. This method combines the benefits of the two most used procedures.
    • Patients who suffer from excessive hand sweating as well as armpit sweating can benefit from a slightly modified ETS approach.

    Learn more about Surgical Treatment of Axillary Hyperhidrosis


  4. Even though ETS and ELS are very effective in treating hyperhidrosis in specific areas these surgeries cannot be performed at the same time. At least 4 months should be allowed between each surgery. This time allows the body to adjust to physiological changes. It is up to the doctor and patient to determine which surgery is most appropriate for the patient.

Advantages to ETS:    For more information on ETS click here
  • ETS is the only procedure available that provides the possibility for a permanent solution to hyperhidrosis.
  • The procedure is proven to be safe and effective.
  • Dr. Reisfeld is highly experienced, performing the procedure on almost a daily basis.
  • Patients are able to leave the same day of the procedure.
  • Patients are able to return to their normal daily routine within a short time.


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Details of the surgery (ETS - Endoscopic Thoracic Sympathectomy):
  • Under general anesthesia, a small incision, approximately one centimeter (less than ½ inch) in length, is made under both armpits.
  • Air is inserted through the incision into the chest cavity. The reason for the air is to push the lung away from the operative site. At no time does the lung collapse because we use single lumen intubation. This means that air is exchanged through both lungs throughout the entire procedure. Different ETS surgeons use different techniques including the use of double lumen endotracheal tubes, which in turn, leads to a collapsed lung. Even with a collapsed lung, however, the lung will go back to its normal position once it is inflated again.
  • Endoscopic equipment (a fiber optic camera and a working instrument) is then inserted. Two high-resolution monitors are placed at either side of the patient so the doctor has a perfect view of the custom-made instruments he is using. The sympathetic chain is located along the rib's head.
  • The sympathetic chain is located along the rib's head.
  • The endoscopic instrument is used to clamp the T3 to T4 segment of the sympathetic nerve node responsible for the cause of excessive sweating. Four titanium clips are placed on each side of the nerve chain. At the international conference held in Finland in 2001, leading hyperhidrosis surgeons discussed a theory with regard to the exact level of performing the sympathectomy. In other words, the theory proposed the idea that lowering the level of the sympathectomy to T3 and T4 levels will in return reduce the amount of compensatory sweating. The idea of doing ETS only at the T4 level to reduce the amount of compensatory sweating did not prove to be true. Patients who only had the T4 level sympathectomy, done by other surgeons, did not achieve total dryness and therefore had to have redo operations.

    The theoretical basis for this idea is the fact that most of the sympathetic innervation to the head area originates at a T2 level. Leaving this segment intact, renders more body surface (upper body) with sympathetic innervation which results in less compensatory sweating. In 2006 Dr. Reisfeld completed an important clinical study on patients and showing that the number of patients with severe compensatory sweating was reduced when the procedure was done at the T3-T4 level compared to the T2-T3 level. At the present time, for patients with the typical presentation of sweaty hands, sweaty feet, and armpit sweating, Dr. Reisfeld is doing the sympathectomy on the segment between the 3rd and the 4th rib. More clinical studies and research will need to be done to prove this further but Dr. Reisfeld is very pleased with the findings so far.

  • Once the surgery is completed, the air is taken out and the lung returns to its normal position. The instruments are carefully removed.
  • The incision is then sutured internally with absorbent sutures. This eliminates the necessity for sutures removal.
  • The process is then repeated on the other side of the chest.
  • At the present time, clamping is the procedure of choice and the one recommended by Dr. Reisfeld. The primary reason for using the clamping procedure is that it leaves the possibility for easier reversal. Easier technically and physiologically. In the cutting method, when a patient is unhappy with the results of the procedure a reversal may be done by performing a nerve graft operation. This procedure is much more involved and time consuming as compared to clamp removal. In the clamping method, reversal is much easier because it simply requires removal of the clips and by doing so gives the nerve segment a possibility for regeneration. It has been shown that some patients having the clamps removed showed lessening of the compensatory sweating (compensatory hydrosis or reflex sweating) to total disappearance of the compensatory sweating.
  • Patients who have an equal problem with the severity of their sweating in the hands and armpit area will benefit from the endoscopic thoracic sympathectomy on levels T3-T4-T5.

    In other words for those patients who explain that their excessive hand sweating is equal to their excessive armpit sweating adding sympathectomy at the T5 level will give them a higher chance of slowing down or eliminating their armpit problem as well. On the other hand if patients only have excessive armpit sweating Dr. Reisfeld's current opinion is that sympathectomy should not be done for isolated armpit sweating only.

    What happens to the rest of the sympathetic chain?
    There is tremendous overlap in function within the sympathetic chain, so there are no known long-term side effects.

    Do you collapse the lungs during surgery?
    No, the method that is being used by Dr. Reisfeld is a single lumen intubation which allows air to go in and out of the lungs at all times. Those surgeons that are using the double lumen technique the lung on the operated side is being collapsed.

  • Dr. Reisfeld has performed dozens of clamp removal procedures. The results are not 100% but about 50% of those cases showed improvements in their clinical condition which translated into reduction of compensatory sweating, better exercise tolerance, re-appearance of sweat in the hands and upper body, etc. Obviously more time is needed to come to any definite conclusions and also we will need more cases so statistical analysis can be made.
  • Most patients are able to walk out of the medical center within 2 hours after surgery. Regular physical activity and returning to work are possible in one week or less. Scarring is minimal as the incisions are small and well hidden in the folds of skin of the armpit.
  • Dr. Reisfeld personally checks up with each of his patients post surgery to ensure they are perfectly taken care of and to answer any and all of their questions. Dr. Reisfeld takes pride in his excellent patient care; this is very evident by reading any of the patient testimonials. To read what patients, from all walks of life have to say about Dr. Reisfeld, click here.

To learn more about how this life changing procedure could possibly help you please contact us.

Do you have a question that is not answered here? Just ask and we will answer. To ask your question click here.

Lumbar Sympathectomy:
This particular procedure was added to the variety of surgical treatments for focal hyperhidrosis only in the last few years. Pioneering work was done in Brazil, Austria and France and it showed that lumbar sympathectomy could be done efficiently safely and successfully for those patients with excessive plantar hyperhidrosis (foot sweating). There was a notion that doing this procedure could not be done safely enough but the work that was done in those countries showed it not to be true.

In this procedure access is made to the sympathetic chain that runs along the lumbar vertebrae. The operation is done under general anesthesia and takes about 1 to 2 hours. Patients typically go home/hotel the same day however in rare instances some patients stay at the hospital for one night and then go home the next day.

If the operation starts early in the morning and the anatomical relations are displayed easily and nicely, the resultant pain and discomfort can be brought down to a minimum enabling the patient to leave the hospital in the late afternoon. Typically patients can return to normal activities such as work within a few days.

In rare cases the patient's anatomy may be more difficult so the operation may take a little longer. It should be re-emphasized again that because this is a more involved operation some patients may need a slightly longer stay at the hospital. Dr. Reisfeld is always cautious to ensure the patients safety and well-being so travel plans may be adjusted accordingly. With the experience accumulated over the last few years it became obvious that athletes, with very developed lumbar area muscles, the sympathetic chain might be buried between or underneath the muscle. It takes a lot of knowledge of the anatomy and experience to overcome this particular finding.

Basically the operation can be done endoscopically. In this approach there are three small cuts made on the side of the abdomen (flank region). And through those cuts endoscopic equipment is being inserted, a space behind the stomach is developed and then the sympathetic chain running along the lumbar vertebrae is located. The sympathetic chain is then clamped below the level of the second lumbar vertebra. It is important to be in that level to reduce the chances of side effects. At times there is a need to check the exact placement of the clamps using x-rays at the time of the operation. In very rare cases there is a necessity to convert the operation from an endoscopic approach to an open approach and the only difference is that one of the incisions is slightly longer. The amount of pain and the time spent at the hospital are the same. Among the reasons that sometimes necessitate conversion to an open approach are obesity, anatomical variations and safety. The operation has about a 98% success rate and it can help those patients where plantar hyperhidrosis is a major problem.

To learn more about how this life changing procedure could possibly help you, please contact us.

Do you have a question that is not answered here? Just ask and we will answer. To ask your question click here.

Laser Armpit Sweat Treatment for Excessive Armpit Sweating:
Excessive armpit sweating beyond the normal physiological needs can be bothersome, unpleasant and debilitating. This can happen as a primary presentation of focal hyperhidrosis with or without excessive hand sweating. There are numerous conservative antiperspirants on the market and obviously those should be the first approaches tried to deal with this problem. If those over the counter products are ineffective then there are products containing aluminum chloride ingredients that can help. They come in different strengths, some such as Maxim can be purchased online and those with the highest concentration of aluminum chloride can be obtained with a prescription.

Surgical solutions for excessive armpit sweating were available for many years. Basically those procedures involved cutting the skin from the armpit area. It was a good solution but it created big scars and sometimes scarring that prevented a full range of motion in the armpit/shoulder area. Over the last few years Botox injections became a fashionable solution but a major drawback to the Botox injection was the temporary nature of the help they provided.

Energy produced by a high precision laser was added to the techniques used by surgeons to treat excessive armpit sweating. Initial results were good but long term follow up showed that the laser technique by itself does not produce the same end results that can be achieved when in combination with axillary suction currettage (mechanical portion of the operation). As a result of this observation the combination of both methods is now used by Dr. Reisfeld for an improved treatment of excessive armpit sweating. The laser beam is used initially to separate the subdermal layers and at the same time eliminating as many sweat glands as possible. This is followed by the axillary suction currettage which is the final step in eliminating the sweat glands.

The procedure is short and results in a minimal amount of pain. Some swelling and discomfort are to be anticipated but those are temporary.

To learn more about how this life changing procedure could possibly help you please contact us.

Do you have a question that is not answered here? Just ask and we will answer. To ask your question click here.

It is important to note that patients should always try conservative methods and consult with their doctors before embarking on a surgical approach.


Groin Sweating:
For those patients who suffer primarily from groin sweating visit our new groin sweating page to learn about the options available.

Questions

Can I do the operation if I have scoliosis?
Yes, but we would need to know the degree of scoliosis. In experienced hands this anatomical variation can be handled. But experience is needed to locate the nerve which could slightly be off the regular course.



The information on this site is not to be used for diagnosis and or treatment, or to be used in place of professional medical advice from your doctor or physician. This web site is intended as an introduction to Suction curettage. When considering this or any surgical procedure, consult with your surgeon for any additional information regarding the surgery, risks, complications, recovery and results.