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Versión Español
22/02/2012
| Contents: Dr. Joaquín García-Morato |
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A cure for severe hand and feet (plantar) sweating
A lot of information can be find in internet about Hyperhidrosis and its cure. Many surgeons perform the procedure for hand sweating.
We offer a “State of the art” surgery performed for one of the most experienced teams at a very convenient price/quality ratio, for both hand and/or feet sweating.
Recognition, diagnosis, and treatment of primary focal hyperhidrosis
Journal Academy of Dermatology 2004;51:274-86.
John Hornberger, Kevin Grimes, Markus Naumann et al
Thoracic Sympaticothomy or Sympatectomy (ETS or ETS©)
We have a program for surgical treatment of Hyperhidrosis, pioneer in Latin America since 1996. The procedure is performed on an outpatient basis (6hs. in the clinic), or as an overnight stay. General anesthesia with an endotracheal tube is used. The thoracic cavity is entered under the armpit with an optic through a 1 cm incision. The sympathetic nerves are cut or clamped by applying removable titanium clips through a second 5 mm skin incision next to the previous one. Both sides are operated on under the same anesthesia. The clip application, as opposed to the diathermia cutting, makes the procedure "potentially reversible" if excessive sweating of the trunk appears after surgery. We have been using the clipping method since 2001, and up to now no patient has asked to have the clips removed.
Side effects
ompensatory sweating is an excessive sweating on the back, abdomen, thighs, and/or lower legs after surgery. This should be expected to a certain degree in 50% of the patients. Compensatory sweating is not constant. This is likely to happen in hot environments. Those who sweat from the trunk prior to surgery are more prone to get severe compensatory symptoms following surgery.
A modest decrease in heart rate (approximate 10%) at rest and during high exercise demand may be experienced in some patients. If it occurs, it has no physiologic consequences.
Some patients (˂ 15 %) can experience increased sweating in the head and neck area while eating or smelling spicy food (gustatory sweating)
Possible complications
No operation is without risks. Complications are not common in this surgery. Potential complications may include the following:
Pneumothorax
Bleeding
Injury to surrounding organs
Neuritic pain
Anesthesic complication
http://www.sts.org/patient-information/other-types-surgery/hyperhidrosis
Surgical Approaches and Techiques in the Management of Severe Hyperhidrosis
Thoracic Surgery Clinics May 2008. Vol 18 N°2 167-181
Fritz Baumgartner
Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis
Annals of Thoracic Surgery 2003;75:1075-9
Gossot D, Galetta D, Pascal A et al.
Superiority of thoracoscopic sympathectomy over medical management for the palmoplantar subset of severe hyperhidrosis Ann Vasc Surg.
Annals of Vascular Surgery 2009 Jan-Feb;23(1):1-7. Epub 2008 Jul 10.
Baumgartner FJ, Bertin S, Konecny J.
The Boräs experience of endoscopic thoracic sympathicotomy for palmar, axillary, facial hyperhidrosis and facial blushing
European Journal of Surgery 1998;164(Suppl 580):23-26
Rex LO, Drott C, Claës G et al.
Contraindications for surgery
Severe previous or current illness (particularly cardio-respiratory or pleural disease) could be a contraindication for the procedure (See preoperative test).
Lumbar Sympathicotomy or Sympathectomy
The surgery is done under general anesthesia. The retroperitoneal space (lumbar) is entered with an optic through a 2 cm incision. Two additional 0,5 cm skin incisions are needed. The sympathetic nerves are cut or clamped by applying titanium clips. The proceeding takes 60 to 90 minutes each side. Generally, both sides are operated on under the same anesthesia. We perform the lumbar operation as an overnight basis. Generally ladies are much more interested in the cure of feet sweating.
Side effects
Compensatory sweating is a potential risk and should be expected to a certain degree. It is not as usual as for ETS.
Possible complications
No operation is without risks. Complications are not common in this surgery. Potential complications may include the following:
Bleeding
Injury to surrounding organs
Neuritic pain
Anesthesic complications
Endoscopic lumbar sympathectomy following thoracic sympathectomy in patients with palmoplantar hyperhidrosis.
World Journal of Surgery 2011 Jan;35(1):49-53.Rieger R, Loureiro Mde P, Pedevilla S, de Oliveira RA.
Retroperitoneoscopic Lumbar Sympathectomy for Plantar Hyperhidrosis
Journal American College of Surgeons Vol. 209, N°.2, August 2009
Kalpesh Jani
Endoscopic lumbar sympathectomy for plantar Hyperhidrosis
British Journal of Surgery 2009; 96: 1422-1428
R. Rieger, S. Pedevilla and S. Pöchlauer
Laparoscopic lumbar sympathectomy for lower-limb disease
Surgical Endoscopy (2002) 16: 500-503
S. Watarida, S Shiraishi, M Fujimura et al.
How to arrange the surgery. Practical aspects
All previous arrangements can be done by e-mail, Skype or telephone.
We will ask you to fill out a preoperative questionnaire that will allow us to know more about you.
Before we schedule your surgery, you need your preoperative test done.
We schedule surgery 2 to 4 weeks in advance.
For foreign patients living abroad, we usually proceed as follows:
Day 1
The Surgery will be done at "Clínica del Sol". After surgery you will be monitored for 4 to 6 hours in the outpatients facility before leaving the Clinic.
Day 2
In order to have surgery as an outpatient basis (the patient spends about four to six hours in the recovery room and then is able to return to his hotel/apartment), we recommend coming with somebody else (a relative or friend). If you come alone, we recommend that you stay overnight in the Clinic.
FAQ
Who performs the surgery?
Dr. García-Morato himself performs all the procedures (more than 650 Simpathicotomies), with the collaboration of a second surgeon, the anesthesiologist and the scrub nurse. In the operating room there will also be a cardiologist and nurses.
Where is the procedure performed?
The surgery is performed at the Clínica del Sol, a state-of-the-art facility, in Recoleta neighborhood. It is about 25 block from Buenos Aires down town. www.cdelsol.com.ar
How long does it takes to return to normal activities?
Return to daily activities or work can be accomplished in 2 to 3 days.
Do the clamps set off alarms in airport metal detectors?
The titanium clips will not set off any metal detectors.
It is possible to know in advance who will have compensatory sweating?
No. Those who sweat from the trunk before surgery have more chances of having compensatory sweating. It doesn't mean that those who don't sweat from the trunk before surgery have no risk of compensatory sweating.
What is the cost of ETS©?
There is an inclusive charge that covers the facility, anesthesia, and the surgical fees. After receiving your preoperative questionnaire, we will be able to inform you of the total price of ETS© surgery.
1980
M.D. Buenos Aires University
1982-85
Resident. General Surgery. Buenos Aires University
1987-88
Resident. Thoracic and Vascular Surgery. Avignon, France
1986
Argentinean Board in General Surgery. Buenos Aires License
1988
Argentinean Board in General Surgery. Argentine Association of Surgery
1991/Present
Teaching Position. Thoracic Surgery. Buenos Aires Medical School
1993
Argentinean Board in Thoracic Surgery. National Healthwellfare
1993
Recertification - Board in General Surgery. Argentinean Association of Surgery
2000/Present Chief Thoracic Surgery. Institute of Medical Research, Buenos Aires University
2003
Member of International Society of Sympathetic Surgery
2004
Member International society of Hyperhidrosis
2004
Recertification - Argentinean Board in Thoracic Surgery. Argentinean Society of Thoracic Surgery
"Primary Craneofacial Hyperhidrosis. Surgical Treatment". Medicina Vol.60, Supl. 1- 2000 pag.123.
"Argentinean Experience from a Single Surgical Group in Endoscopic Thoracic Sympathicotomy". Clinical Autonomic Research 2003, 13:158
"Hemodinamic and Gasometrical Changes during General Anesthesia for sympathicothomy". Clinical Autonomic Research 2003, 13: 160
"Gasometrical Changes during Bilateral Thoracoscopic Simpathicotomy". Archivos de Bronconeumología, Vol. 40, Sup. 4 - 2004, pag.113.
"Primary Palmar Hyperhidrosis. Surgical Treatment in 172 Patients". Medicina Vol. 66 (Supl I), 2006, pag. 54
"Arterial Oxigenation during Bilateral Toracoscopic Simpathectomy at T2-T3 Level" Medicina Vol. 68 (Supl. I) 2008, pag. 45.
"Videothoracoscopic Simpathectomy in Severe Vascular Disorders of the Upper Limb" Medicina Vol. 68 (Supl. I) 2008 pag. 62
Congresses
Second Inernational Symposium on Thoracoscopic Sympathicotomy. Boräs, Suecia, 1997.
"Sympathectomy in Hyperhidrosis". Speaker. Argentinean Congress of Dermatology. Buenos Aires, 1998
Speaker: "Surgery of primary Hyperhidrosis". II International Symposium. Proceedings in Surgery and Dermatology. Buenos Aires, 1998.
"Surgery of Social Phobia". Speaker. II Symposium. Argentinean Society of Anxiety Disorders. Buenos Aires, 1998
"Results of Surgery in Primary Hyperhidrosis. II Symposium. Argentinean Society of Anxiety Disorders. Buenos Aires, 1998.
Speaker: "Sympathicotomy in Primary Hyperhidrosis". Annual Course of Pediatric Dermatology. Ramos Mejía Hospital, 1999.
Speaker: "Primary Craniofacial Hyperhidrosis. Surgical Treatment". 8° International Congress of Internal Medicine. Hospital de Clínicas, 2000.
Attending: "5° International Symposium of Sympathetic Surgery" Erlangen. Germany 2003.
Speaker: "Argentinean experience from a single surgical group in endoscopic thoracic sympathicotomy". 5° International Symposium on Sympathetic Surgery" Erlangen. Germany 2003.
Speaker: "Hemodynamic and gasometrical changes during general anesthesia for sympathicothomy". 5° International Symposium of Sympathetic Surgery. Erlangen, Germany 2003.
Speaker: "Surgery of the Autonomic Nervous System". Workshop. Hospital de Clínicas. Buenos Aires, 2004
Attending: "6° International Symposium of Sympathetic Surgery". Vienna, Austria. 2005.
Course: "Thoracoscopic Reconstruction of Sympathetic nerve" Vienna, Austria, 2005.
Presentation: "Bilateral Thoracoscopic Sympathectomy with single lumen endotracheal tube in Palmar Hiperhidrosis". South American Congress of Thoracic Surgery. Concepción, Chile 2005.
Speaker: Surgical treatment of somatic manifestations of Anxiety Disorders. Regional meeting World Psythiatric Asociation .. Buenos Aires 2006.
Speker: "Primary Palmar Hyperhidrosis. Surgycal treatment in 172 patients". 11° International Congress of Internal Medicine. Buenos Aires 2006.
Chairman "Anesthesic Proceedings in Sympathectomy". 7° International Symposium of Sympathetic Surgery". Recife, Brazil. 2007.
Attending: 7° International Symposium of Sympathetic Surgery. Recife, Brazil 2007.
Training: Lumbar Sympathectomy for plantar Hyperhidrosis. Merano and Brescia, Italy 2009.
Training: Reconstruction "reversal" of Thoracic Sympathetic Nerve. Merano and Brescia, Italy 2009.
Mission: The aim of this Web site is to spread general information and possibly treatments about primary Hyperhidrosis and Eritophobia o Social Phobia.
Receiver: The Centro Argentino de Hiperhidrosis y Eritrofobia Website is for patients and their families and friends. Gives information about diagnostic and treatment of excessive sweating (Hyperhidrosis) and social phobia (Blushing). The information provided on this site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician.
Bibliography: The information of this site is based on international medical references and links to scientific societies.
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