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 treatments 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. That being said, the current thought is that main reason for that difference is the fact that most of the sympathetic innervation to the plantar sweat glands originates in the lower thoracic sympathetic ganglia and the first lumbar ganglia. By doing the thoracic sympathectomy those ganglia are not affected by the ETS surgery basically saying is that the sympathetic nervous system is made up of multiple sites that have different functions.
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. Also by obtaining anatomic knowledge about the distribution of the sympathetic nerves in the lumbar region we know now that as long as you stay with the blockade level at or below lumbar vertebra #2 there is no influence on the male ejaculation process.
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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