Palmar hyperhidrosis vs. Plantar hyperhidrosis
Most patients who suffer from palmar hyperhidrosis or excessive hand sweating will also have excessive feet or plantar hyperhidrosis. In the past when local measures such as drysol, drionic or any other conservative measures did not help patients then looked to surgical alternatives. Endoscopic thoracic sympathectomy (ETS) is very effective with the treatment of palmar hyperhidrosis but for plantar hyperhidrosis it is not as effective. The reason for the difference in success rates is not well known.
The sympathetic chain in the lumbar region controls excessive plantar sweating. Up until about a few years ago there was some hesitation in performing lumbar sympathectomy as well upper thoracic sympathectomy because of the fear of sympathetic dysfunction and for males patients the side effects of retrograde ejaculation. Over the last few years additional clinical work has been carried out in South America as well as in Europe that shows performing lumbar sympathectomy after upper thoracic sympathectomy does not cause sympathetic dysfunction and does offer a good rate of success for excessive plantar hyperhidrosis. The question of retrograde ejaculation is not yet solved.
Bilateral lumbar sympathectomy can be carried out on an outpatient basis or a very short hospital stay. It involves three small cuts on the left as well as the right flank. The sympathetic chain at the L2-L4 level is clamped.
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