Hyperhidrosis surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]
Surgery
- Sweat Gland Suction:
A new technique adapted and modified from liposuction. On an out-patient basis with only local anesthesia, the sweat glands are permanently removed in a gentle, non-aggressive manner. The sweat glands and armpits are first softened and anesthetized with a special solution. After a short period, the sweat glands can then be removed in a manner similar to liposuction. Only small incisions above and under the armpits are required to remove the sweat glands through quick suction. The entire minimally invasive operation takes between 60 and 90 minutes. Patients can go home directly after the procedure. Some can even return to work after leaving the practice, although taking the rest of the day off is recommended. Over 95% of patients report considerably less discomfort and permanent dryness.
- Endoscopic thoracic sympathectomy or ETS):
Select sympathetic nerves or nerve ganglia in the chest are either cut or burned (completely destroying their ability to transmit impulses), or clamped (theoretically allowing for the reversal of the procedure). The procedure often causes anhidrosis from the mid-chest upwards, a disturbing condition. Major drawbacks to the procedure include thermo regulatory dysfunction (Goldstien, 2005), lowered fear and alertness[1] and the overwhelming incidence of compensatory hyperhidrosis. Some people find this sweating to be tolerable while others find the compensatory hyperhidrosis to be worse than the initial condition. It has also been established that there is a low (less than 1%) chance of Horner's syndrome. Other risks common to minimally-invasive chest surgery, though rare, do exist. Patients have also been shown to experience a cardiac sympathetic denervation, which results in a 10% lowered heartbeat during both rest and exercise. ETS was thought to be helpful in treating facial blushing and facial sweating. According to Dr. Reisfeld,the only indication for ETS at present is excessive and severe palmar hyperhidrosis (excessive hand sweating). Statistics have shown that when treated for facial blushing and/or excessive facial sweating, the failure rate of ETS for those two clinical presentations is higher and patients are more prone to side effects.[2]
- Percutaneous Sympathectomy: a minimally invasive procedure in which the sympathectomy nerve is blocked by an injection of phenol.
Lumbar sympathectomy is a relatively new procedure aimed at those patients for whom endoscopic thoracic sympathectomy has not relieved excessive plantar (foot) sweating. With this procedure the sympathetic chain in the lumbar region is clipped or divided in order to relieve the severe or excessive foot sweating. The success rate is about 97% and the operation should be carried out only if patients first have tried other conservative measures.[3]
This type of sympathectomy is no longer considered controversial in regards to hypotension and retrograde ejaculation.[4][5]
The development of retrograde ejaculation, inability to maintain erection and hypertension as a result of this surgery appears to be rare to non-existent; journal articles describing the technique and case reports suggest that none of 18 men undergoing the procedure at two separate surgical units experienced sexual disability following surgery, while no mention is made of hypertension or sexual disabilities occurring in female patients.[4][5]
References
- ↑ Pohjavaara P, Telaranta T, Väisänen E (2003). "The role of the sympathetic nervous system in anxiety: Is it possible to relieve anxiety with endoscopic sympathetic block?". Nordic journal of psychiatry. 57 (1): 55–60. doi:10.1080/08039480310000266. PMID 12745792.
- ↑ Reisfeld, Rafael. "Sympathectomy for hyperhidrosis: should we place the clamps at T2-T3 or T3-T4?" Clinical Autonomic Research, December 2006, Volume 16, Number 6.
- ↑ Reisfeld, Rafael (2008-05-04). "Lumbar Sympathectomy". Retrieved 2008-05-04.
- ↑ 4.0 4.1 Rieger, R.; Pedevilla, S. (2006). "Retroperitoneoscopic lumbar sympathectomy for the treatment of plantar hyperhidrosis: Technique and preliminary findings". Surgical Endoscopy. 21 (1): 129–35. doi:10.1007/s00464-005-0690-8. PMID 16960674.
- ↑ 5.0 5.1 Reisfeld, Rafael (2011-02-11). "Lumbar Sympathectomy with Clamping Method Paper". Retrieved 2011-02-11.