Dr Slobodan Mirosavljev
+381 64 17 05 947 slobodan777@yahoo.com

Dr. Giudiceandrea Alberto
+39 3333740186 agiudi@yahoo.com

Plantar Sweating and Lumbar Sympathectomy


Plantar sweating occurs in 95% of cases always with the palmar sweating. More women than men suffer from it . Many patients have already been operated on thoracic sympathectomy. This is because in most cases (but not in all …) the most annoying symptom is palmar sweating . Thoracic sympathicotomy can solve the problem only in 30% of the cases. Plantar sweating can cause enormous stress especially if the foot is an important part of our body that we want to show. This is often the case in women. In the men normally plantar hyperhidrosis and accompanied by bromidrosis and here the indication to do the surgery are different than in the woman


The dermatolgist use the classic remedies as antritraspiranti, and ionophoresis for the sweat without odor. if it is also present unpleasant adore (bromidrosi) this must be fought trying to reduce the bacterial load on the feet through disinfectant baths if the medical treatment  do not work surgical treatment  is possible


This is a new technique (performed about 10 years ago for the first time in Brazil similar to the well known thoracic sympathectomy performed for palmar hyperhidrosis.) The principle is the same: the lumbar sympathetic nerve in the lumbar region is blocked practically behind the kidneys. Unlike thoracic sympathectomy where the nerve is easily seen inside the rib cage in lumbar sympathectomy, the nerve is to be sought as it is in the tissue. Normally it is found at the base of the veterinary column right from the vena cava and at the left from the aorta. Clippetine is applied after having identified a ganglion cranially and distally to it.


How does the intervention take place? The operation is done bilaterally (the sympathetic nerve goes to the right face and vice versa) in the same session. The surgery takes about 90 minutes minutes under general anesthesia. You are discharged the following day

What risks does the endoscopic surgeon involve? It is a relatively free operation even if it is still an intervention. In man and known retrograde ejaculation This arises from a lesion of the lumbar sympathetic at the level of the 2 Ganglion and it happened ferquently in a chemical or percutaneous sympathomosis in which alcohol is injected into the paravetrebral space to destroy the nerve. The alcohol spread without exact control and damaged the whole lumbar sympathetic chain. In the retroperitoneoscopic technique, the most distal gangio is selectively clipped and there has been no single case of retrograde ejaculation. Even a control of the specific literature in the subject shows that this complication belongs more to the world of percutaneous sympathicomy than to lumbar sympathectomy under direct mink.

Side effects ? Compensatory sweating: compensatory unlike thoracic sympathectomy and present in a truly negligable manner such that in most cases it is not noticed. This is explained by the fact that the feet do not actively participate in body thermoregulation

Is the percutaneous technique with needle or the retroperitoenoscopic technique preferable? The retroperitoneoscopic technique should be preferred to avoid complications such as retrograde ejaculation. Moreover the nerve damage in the percutaneous technique is very extensive (it can damage all the sympathetic lumbar while in the technique under the mink nerve damage and minimal

L2 L3 L4? This question does not arise in endoscopic sympathectomy, since the anatomy of the ganglia varies from person to person and is subject to enormous differences between individuals. In principle, the lowest ganglion present is blocked. It avoids going up into the renal area where the ganglia that regulate the bladder and ejaculatory functions are located

How long is the hospital stay? the hospital stay is one day. The pains are normally less than in thoracic sympathectomy. since the anesthesia lasts longer, even the after-effects of it last longer and the resumption of work is possible after 1 week

The intervention is performed bilaterally?: yes, the operation is performed in a single 90-minute session.

How is the intervention performed? The operation is performed under general anesthesia. there are three small cuts in the lumbar region and a trocar is inserted into the retroperitoneal space. the psoas muscle is reputed and this is performed up to the vetrebral body. Then you look for the nerve that is located in a corner between the vessels the psoas muscle and the vetrebral body. The nerve is clipped

Are the scars visible? The surgery is performed with two cuts of 5mm and 1 of 1cm in the lumbar area silla mid-axel line No stitches are placed and the wound is glued.

Trunk symtatectomy or Gangliectomy? The sympathectomy (application of the clip on the trunk of the sympathetic nerve or cut) and superior to the commonly performed gangliectomy (the ganglia are removed with the sympathetic nevus) or an electrocoagulation of the ganglia being much less destructive than tissue, a minor intervention with fewer risks, with minor side effects and equal effectiveness. In the percutaneous technique with needle the nerve and the ganglion are coagulated or burned with alcohol and therefore destroyed forever

Is the intervention reversible? The intervention is reversible only in the first two or three weeks. In theory, reversability is only provided for males who may have complications such as retrograde ejaculationH