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Surgical
Treatments for excessive sweating and hyperhidrosis
ETS
or Endoscopic Thoracic Sympathectomy is a surgery that has
gained popularity in the past 3 years, although it was first
performed in 1987. The following is a detailed description
of the surgery as described by Dr. Reisfeld who was
my surgeon who performed the surgery:
Under
general anesthesia, a small incision, approximately one centimeter
in length is made under both armpits. Air is inserted though
the incision into the chest cavity. Endoscopic equipment (a
fiberoptic camera and a working instrument) is then inserted.
The sympathetic chain is located along the ribs head. The
endoscopic instrument is then used to clip or cut the T2 segment
of the sympathetic nerve node responsible for the sweating.
Once completed, the air inflating the chest cavity is removed,
along with the instruments and the lung returns to it's normal
position. The incision is then sutured internally with absorbent
sutures which eliminate the necessity for sutures removal.
The process is then repeated on the other side of the chest.
Clipping as a method is performed as well, although it requires
one additional port. The theory behind the Clipping is theoretical
possibility of reversal if the side effects are too severe
for patients to tolerate and if it is done in the appropriate
time interval. Dr. Reisfeld does these cases after complete
discussion and understanding by the patient about this particular
method. At present Clipping is the procedure of choice and
the one recommended by Dr. Reisfeld. The main reason for that
is the theoretical possibility of reversal. Scarring is minimal,
as the skin cuts made are small and well hidden in the folds
of skin in the armpit.
I
would like to add a personal note about Dr. Reisfeld. He is
the most caring surgeon you are ever going to meet. He provided
excellent service and was very attentive to me the day of
my surgery and followed up with me in my hotel room across
from his center at least 3 times before I flew back home.
Dr.
Jim Garza is also a very nice surgeon. I have spoken with
him personally and know people who have had surgery from him.
He comes highly recommended as well.
Patients
with axillary hyperhidrosis who are unresponsive to medical
therapy can be effectively treated by excision of the axillary
sweat glands. If sweating extends beyond the hairy portion
of the axilla, several skin incisions may be needed, sometimes
resulting in formation of hypertrophic and/or constrictive
scars.
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