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Hyperhidrosis Surgery

Dr. Reisfeld is one of the world’s 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 surgeon in the world who is an expert at all three major procedures listed below. This gives him unparalleled expertise in performing these surgeries:

  1. For those who suffer primarily from severe and excessive hand sweating (palmar hyperhidrosis), 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 see any results from endoscopic thoracic sympathectomy, endoscopic lumbar sympathectomy is appropriate. Learn more about Endoscopic Lumbar Sympathectomy (ELS)
  3. For patients suffering from excessive armpit sweating (axillary hyperhidrosis), the current method is axillary suction currettage.
    • 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 6 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 of ETS Surgery For Hand Sweating

  • ETS is the only procedure available that provides a proven surgical solution to excessive hand sweating (palmar hyperhidrosis).
  • The procedure is proven to be safe and effective.
  • This procedure has a 98-99% success rate.
  • Dr. Reisfeld is highly experienced, performing the procedure on an almost a daily basis.
  • Patients are able to go home the same day.
  • Patients are able to return to their normal daily routine within a short time.
  • For more information on ETS click here

Details of The Surgery (ETS – Endoscopic Thoracic Sympathectomy):

  • The procedure itself is done on an outpatient basis. The patient returns home or to their hotel the same morning.
  • The operation is done under general anesthesia. Two very small incisions are made.
  • Air is inserted through the incision into the chest cavity. The reason for the air is to push the lungs away from the operation site. At no time does the lung collapse because we use single lumen intubation to prevent this from happening. This means that air is exchanged through both lungs throughout the entire procedure. Different ETS surgeons use different techniques. Some surgeons use double lumen endotracheal tubes, which in turn, can lead 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 on 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 endoscopic instruments are 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. In cases of severe armpit sweating, clips are applied on the T5 level. The total amount of clips can range from 4 to 6. 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 showed 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 symptoms of sweaty hands, sweaty feet, and armpit sweating, Dr. Reisfeld performed the sympathectomy on the segment between the 3rd and the 5th 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 suture 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 this clamping procedure, is that it leaves the possibility for easy reversal if needed. If 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 when 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 the ability to regenerate. It has been shown that some patients who had the clamps removed showed less compensatory sweating (compensatory hydrosis or reflex sweating), or a total recovery from their previous symptoms.
    • Patients who have an similar problem with sweating in the hands and armpit area will benefit from the endoscopic thoracic sympathectomy on levels T3, T4, and T5. In other words, for those patients who describe their excessive hand sweating as equal to their excessive armpit sweating, adding sympathectomy at the T5 level will give them a higher chance of minimizing 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 a sympathectomy should not be done for isolated armpit sweating.
    • 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. As the name implies, this is a chain of ganglia and not just one nerve.
    • Do you collapse the lungs during surgery?
      No, Dr. Reisfeld uses the single lumen intubation method. This allows air to go in and out of the lungs at all times. Surgeons that are using the double lumen technique collapse the lung on the side they where they are operating.
    • Dr. Reisfeld has performed dozens of clamp removal procedures. The results vary but about 50% of those cases showed improvements in their clinical condition. This translated into a 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, but even in these scenarios, the results are promising
    • Most patients are able to walk out of the medical center within 2 hours after surgery. Regular physical activity and returning to work are both possible in one week or less. Scarring is minimal (About 10mm or 1cm), as the incisions are small and well hidden in the folds of skin.
    • 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 in any of the patient testimonials he has received. 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 – For Excessive Foot Sweating:

This particular procedure was added to the variety of surgical treatments for focal hyperhidrosis in 2006. Pioneering work was done in Brazil, Austria, and France. This work showed that a lumbar sympathectomy could be done efficiently, safely, and successfully for those patients with excessive plantar hyperhidrosis (foot sweating).

Lumbar Diagram

Lumbarectomy: Anatomical drawing showing where the incisions are made.

In this procedure, the doctor creates an incision to access 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 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, the resulting pain and discomfort can be brought down to a minimum, enabling the patient to leave the medical facility 2-3 hours later. 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, that some patients may need a slightly longer stay at the medical facility. Dr. Reisfeld is always cautious to ensure the patients safety and well-being, so travel plans may be adjusted accordingly.

With the experience accumulated since about 2007, it became obvious that athletes with very developed lumbar area muscles were a special case. The sympathetic chain might be located between or underneath the muscle in these instances. This discovery was crucial, but it also meant that the procedure would need to be altered for athletes.

The operation is done endoscopically. In this approach there are three small cuts made on the side of the abdomen (flank region). The largest cut is about 15mm or 1.5cm, and the other two on each side are about 5-7mm. Through these cuts, endoscopic equipment is inserted. A space behind the abdomen is developed, and then the sympathetic chain running along the lumbar vertebrae is located.

The sympathetic chain is then clamped below the second lumbar vertebra. It is important to be at that level, to reduce the possibility of side effects. The exact location is confirmed with the help of X-Rays during the operation. In extremely rare cases, there may be a necessity to convert the operation from an endoscopic approach, to an open approach. The only difference here, is that one of the incisions is slightly longer. The amount of pain and the time spent at the hospital are the same.

The reasons that sometimes necessitate conversion to an open approach are: obesity, anatomical variations, and safety. The operation has about a 97-98% success rate, and it can help those patients where plantar hyperhidrosis is a major problem.

Make sure before any decisions are made to discuss the particulars of this operations with an experienced hyperhidrosis surgeon. To ask questions and learn more about how this life changing procedure could possibly help you, please contact us.

Treatments for Excessive Armpit Sweating:

    • In isolated cases, excessive armpit sweating can cause substantial discomfort, embarrassment, and social anxiety. There are a lot of treatment options, such as aluminum chloride lotions or antiperspirants. There are many varieties on the market as well (over the counter or prescribed).
    • BOTOX® Cosmetic also exists as a potential treatment to control armpit sweating, but it is costly and temporary.
    • Multiple surgical approaches have been used, from excision of the skin in the armpit area, to less invasive procedures where the inner layer of the armpit area skin is curated. Varying degrees of success have been noted.
    • Laser ablation or energy applied to the armpit through ultra sound ablation were used with somewhat inconsistent results. The opinion held by Dr. Reisfeld, is that the axillary suction curretage option has better long term results, but even in the doctor’s capable hands, results can vary. 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. 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 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. Experience on the doctor’s part is needed to locate the nerve, which could slightly be off the regular course as a result of the condition.

Hyperhidrosis Questions:

For questions please fill out the form on our contact us page so we can better understand your condition in order to better answer your questions.

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.