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Plantar Hyperhidrosis (Foot Sweating)

In the early years ETS had limited success with the resolution of excessive foot sweating (plantar hyperhidrosis) which usually comes together with palmar hyperhidrosis. At a younger age sweaty feet might not be considered as much of a problem as compared to excessive hand sweating. This is based on the fact that physiologically the sweat glands in the feet mature later in life. Obviously as more ETS cases are done around the world the question of what to do with sweaty feet came about. In the mid nineties some pioneering work was done which allowed the development of ELS. With ELS the surgical approach is to eliminate sympathetic innervation to the feet region of the body. This procedure carries with it a high success rate for elimination of sweaty feet in the range of 98%. ELS is usually done for patients in whom ETS did not improve their feet sweating or to patients that have a combination of hand and feet sweating but their main presentation is excessive feet sweating.

Obviously different technical approaches were described over the years when performing ELS and a great deal of success depends on the experience of the performing surgeon. Again here the operation is done on an outpatient basis with a very tolerable amount of discomfort. With this approach there is a chance also for helping compensatory sweating which can appear after ETS on the inner thighs and buttocks.

Combination of Hand and Foot Sweating

In most of the cases patients have sweaty hands and sweaty feet. In the majority of the patients sweaty hands are of a greater concern. This is why, when it comes to surgery, the ETS procedure is the first to be performed with some degree improvement of the feet. If that level of improvement is not enough then later on the ELS surgical procedure can be performed.

A great deal of experience is required to perform endoscopic lumbar sympathectomy successfully. This stems from the basic fact that the performance of the ELS is carried out in a place with the name of retro peritoneal space. Unlike operations that are being done within the chest cavity or the abdominal cavity in this particular operation the surgeon has to create to space through which the operation can be done. It is a delicate process, time consuming and requires a high level of expertise. This is why very few surgeons in the world are able to perform this operation.

Technical Details of the ELS Surgery

The ELS procedure is done under general anesthesia. The patient is in a flat position. Three small cuts are made. The longest one is about 15mm or 1.5cm and the other two measuring about 7mm. Via those incisions the special endoscopic equipment and instruments are inserted and then the lumbar sympathetic chain is exposed. Clips are applied on the sympathetic chain and the location of those clips is verified fluoroscopic equipment (X-Ray). With the clamping method there are a few clamps that are placed onto the sympathetic chain. These clamps are non toxic. They are made from titanium which is an inert material. Why more than one? The clip is very small and has a width of about 1.5mm so order to encompass a segment of the sympathetic chain at least 2 clips are applied at each segment. This is to ensure a total cessation of the nerve signals. Generally speaking the number of clips applied will be anywhere between 3 to 6 clips. The reason for the different numbers depends on the anatomy of the patient and it should be mentioned that the anatomy varies from one patient to another. The clips are so small they will not activate any alarms in the airport security lines. Once one side is finished then the next one is done. The ELS procedure is somewhat longer than thoracic sympathectomy (hands) due to it being a more involved procedure. Once the operation is finished the patient goes to the recovery room. Within about 2 hours after that the patient can typically be discharged.There will be some pain which is controlled with oral medications. This pain becomes mild within 24 hours and then eventually dissipates.

What to expect after the surgery

Patients can walk around the same day. Eat lightly until resumption of bowel activity occurs. A shower can be taken the next day and any residual pain can be controlled with oral medications. Resumption of total normal activity can be anticipated in a few days. Heavy physical activity such as exercise should be postponed until the patient feels fully recuperated. Skin sutures dissolve on their own, there is no need to remove them at a later date.

ELS after ETS

As mentioned ELS can be performed with a minimal of 4 months in between ETS and ELS. The reason for that is to allow the body enough time to physiologically adjust to ETS. Those who choose to go for ELS after having ETS should be aware of the possibility that there hand sweating might fluctuate after the ELS with some recurrence of sweat but it is only for a short time and very minimal. The compensatory sweating may also fluctuate after the ELS procedure. Basically the compensatory sweating is mainly a byproduct of ETS as it appears elsewhere on this website.

Living with Hyperhidrosis Long Term

Even though hyperhidrosis poses a lot of issues (Functionally and Socially) with day to day quality of life it is not directly dangerous to ones life. As you can see in some photos (above) the constant wet to dryness of the skin may cause maceration.

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