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Hyperhidrosis
Side Effects

What are the side effects?

With ETS there are several possible side effects. Compensatory sweating (compensatory hydrosis or reflex sweating) is the most bothersome. Compensatory sweating is experienced as excessive sweating on the back, abdomen, thighs, and/or lower legs. This should be expected to a certain degree in all patients, and it ranges from mild to severe. 3% - 5% of patients will experience more severe compensatory sweating. Severe compensatory sweating or severe compensatory hyperhidrosis will make those patients unhappy. Severe compensatory sweating can be defined as very troublesome especially when it soaks through the clothing. It is a difficult situation especially in hot humid summer days. So far attempts to find a common thread among those patients who develop severe compensatory sweating has not yet yielded any concrete answers. However, most patients say that they are not troubled by this extra perspiration and it is preferable to sweaty palms. A short time after the operation, 3-1/2 to 4 days, some patients will have a temporary recurrence of sweating on their palms. This is a short-lived phenomenon that might last for half a day.

Since compensatory sweating is the most common side effect more should be known about it and what is being done to improve upon it. Over the last several years, the clamping method procedure has created an improvement with regard to the reversal possibility. Recently, lowering the level of the clamps to the third and fourth ganglia has had some positive effects with lowering the amount of compensatory sweating. This portion of the site will be updated as more is known. Dr.Reisfeld is very involved in making sure these types of issues are relayed to the public in order to benefit everyone.

Over the last several years more ETS procedures have been done and obviously since the number of cases has gone up tremendously also the number of cited side effects are on the rise. Side effects, such as fatigue, hair loss, loss of concentration, scalp itchiness, weight gain, shortness of breath, reduction of exercise ability and were all mentioned in an anecdotal fashion by different patients. It should be stressed that this is again on an anecdotal basis and not appearing in a significant number of patients. Not every side effect could be related definitely to the sympathectomy but overall those kind of side effects were mentioned by patients in the past. Any question should be directed to the surgeon before making any decision about the operation. At times, it is difficult to answer patients with regards to those complaints without knowing the initial indication for the ETS or the method in which it was performed.

Obesity
Potential patients who are overweight should be aware that they might get compensatory sweating somewhat easier than a person of normal weight. Patients who already have signs of excessive sweating on other parts of the body (abdomen, back, thighs) besides the hands should be aware that they might develop more compensatory sweating than others.

Gustatory sweating is another side effect which occurs in about 5% of cases. This condition, in which patients notice that they tend to experience increased sweating while eating or smelling certain foods, develops in rare instances. Please discuss side effects thoroughly with your surgeon.

What are the risks and/or possible complications of the operation?
No operation is without risk. Complications are not common for this surgery, but they may include the following: excessive bleeding, infection, and injury to surrounding organs. Pneumothorax, a condition in which air remains in the chest wall, can also develop - although it is both rare and treatable. "Horner Syndrome" (also known as droopy eye syndrome) is also a complication associated with the surgery. This particular and uncommon condition can occur in 0.1% of the cases. Dr. Reisfeld has never had a Horner Syndrome case in all his years of practice (21+ years). In these rare instances, patients have experienced drooping of the upper eyelids, constriction of the pupils, and dryness of the eyes. The Horner Syndrome has not been reported by any of our patients, but all of the above problems can be adequately treated if they occur. Reduction in heart rate is reported in a very small number of cases and usually it does not have physiological significance. On the other hand, some athletes engaged in heavy physical activity, such as marathon runners and tri-athletes, report that they could not reach their maximal heart rate as before the procedure. The exact physiological significance of this side effect has not yet been determined by cardiac physiologists. Because of the significant influence of the autonomic nervous system on cardiovascular function, the effect of T2 denervation on the autonomic control of cardiac function has been investigated. For more information refer to:

Noppen M, Dendale P, Hagers Y, Herregodts P, Vincken W, D'Haens J. Changes in cardiocirculatory autonomic function after thoracoscopic upper dorsal sympathicolysis for essential hyperhidrosis. J Auton Nerv Syst 1996;60:115-20.

Generally, T2 sympathectomy has a beta-blocker-like activity that is thought to affect the heart in a positive manner. Thus, some patients may experience a modest decrease in heart rate at rest and during maximal exercise. We observed a small decrease in resting heart rate in approximately 3% of patients after the ETS procedure. Importantly, there are no reports of any long-term adverse effects of ETS on cardiovascular function. For high-end athletes, there will be an inability to raise the heart rate above 138 beats per minute. However, since the conversion from the T2 to the clamping of the T3-T4 levels, the number of patients complaining about heart rate reduction has decreased, and this is one of the reasons Dr. Reisfeld has decided to move the clamping level to T3-T4 when performing the surgery for Hyperhidrosis. In fact, there are patients whose heart rates went up to 150 – 160 per minute. Serious athletes to whom this lifestyle is important should weigh very heavily the pros and cons of the surgery with regards to their vocation. As more is learned about this, we will share the information on this site.

Do you have any questions that were not answered here? Would you like to speak with Dr. Reisfeld to answer those questions? To learn more about what we can do for you, contact The Center for Hyperhidrosis by clicking here.

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