Endoscopic Lumbar Sympathectomy – Side Effects

As with any surgery one should expect some side effects which are directly related to the operation. Typically patients are able to return to normal life within 2 to 3 days after the operation. Sports activity can be gradually resumed after 2 weeks.

  • Pain – After ELS pain is moderate in nature. As described by all patients it is far less pain than the pain experienced after ETS. The pain is well tolerated with prescribed oral medications and will last a relatively short time (3-4 days). Less than 15% of the patients developed temporary neuralgia which is pain from damage to very small superficial nerve fibers. Whenever skin is cut anywhere in the body there are microscopic nerve fibers which are not seen by the naked eye. These nerve fibers can be cut and result in this temporary neuralgia. This pain can last from a few days to a few weeks but the intensity will go down over time until it’s gone. The typical location of this pain is on the anterior surface of the thighs. Most of time it appears only on one side.
  • Warm Feet – As the direct result of the sympathectomy the blood vessels in the feet will get dilated. This dilation will bring more blood flow to the feet and therefore increased warmth. This is a sign that the surgery was successful. The blood vessels will have their autonomous ability to constrict and dilate according to the needs of the body, so after time the temperature will go back to normal levels.
  • Swelling – As in the previous paragraph successful sympathectomy will bring more blood to the foot region. This increased blood flow will cause some swelling of the feet that will subside as time goes by.
  • Scaring – The three scars on either side of the abdominal wall usually heal very well with very minimal cosmetic issues. At times throughout the healing process those scars will appear red which is the body’s reaction to the dissolving sutures embedded within the skin. Time is needed for full healing and disappearance of the scars.
  • Temporary Dizziness – A very small percentage of patients reported that when they got out of bed quickly, in the first day or two, after the operation they felt dizzy. Again here this is a very temporary result of the increased blood flowing into the lower extremities. All that is needed is just for the first day or so for patients to get out of bed slowly so they can avoid this feeling.
  • Possible Constipation – The instruction given to patients after endoscopic lumbar sympathectomy (ELS) is to renew normal diet in a very slow fashion until the patient passes flatulence (gas). There are two reasons why the total resumption of bowel peristaltic activity can be delayed. 1) The ELS is done in an area behind the abdominal cavity (retro-peritoneal area) which is in close proximity to nerves who are feeding the bowel, small and large and with this close relation some delay in the resumption of the normal activity can happen. The instructions that are given to the patient (post surgery) is not to go and have a full diet right away but to wait until flatulence (gas) starts again. 2) It is likely that every patient uses a certain amount of pain killers. It is well known that all pain killers have some inhibiting effects on the peristaltic activity of the bowels. In order to prevent a lengthy constipation one is advised to use any laxative as long as they are still using the oral pain medications.
  • Other extremely rare side effects include the possibility of more prolonged pain in the lower and upper legs (less than 1%). This could be due to prolonged dilatation of the blood vessels with increased blood flow to the legs and feet. This increased blood flow causes some swelling in the leg muscle compartments and therefore patients can experience prolonged pain. This can last weeks. We have observed improvement in the amount of pain and swelling in patients who experienced this kind of pain. What was common in this very small subset group of patients was the fact that those patients returned to regular physical activity very quickly. Extensive investigations to find the source for this pain did not show any abnormality. The best advice that we can give to patients is to slowly return to their normal physical activity. Eventually the this type of pain will go away.
  • Sometimes after ELS for those patients who had previous ETS patients can see some changes in sweating patterns that they did not experience after their ETS procedures. They might have some sweat on their scalp hair that was not there before. Most likely this is a temporary and short lived phenomena which most likely is the result of different stimuli sent to the brain after the ELS procedure. One should always bear in mind that the sympathectomy procedure is a mechanical operation for a physiological problem which creates a need for some time for the body to get adjusted to the new procedure that was done and in those cases was ELS. It is usually a temporary issue that resolves itself over time.

ELS and compensatory sweating

Most of the patients who come for ELS are patients who previously had ETS. The level of compensatory sweating is usually determined by the previous ETS procedure. A very small number of patients were done with ELS as the first procedure. In cases where ELS was done first there is an amount of compensatory sweating but usually it is much less than after ETS. Since that number of patients done with ELS first is small no definite statistical conclusion can be obtained. This could change with time.

As a rule adding the ELS procedure after ETS does not block any more sympathetic chain segments that were already blocked by ETS earlier. We know this may be a bit confusing so please contact us or your hyperhidrosis surgeon to ask questions.

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