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What are the side effects for Endoscopic Thoracic Sympathectomy?

ETS (Endoscopic Thoracic Sympathectomy) related Side Effects:

As with any surgical procedure there are certain risks. Dr. Reisfeld is one of the most experienced and recognized hyperhidrosis surgeons in the world and he takes the time to explain both the benefits and the risks associated with the procedures to all his patients. We encourage you to discuss all your concerns with Dr. Reisfeld and he will be happy to answer your questions. He has received every question imaginable so do not be afraid to ask! (See our frequently asked hyperhidrosis questions section)

Most common side effects for the ETS Procedure (Sweaty Palms):
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. Most patients will develop mild to moderate compensatory sweating which is much preferable over the sweaty hands they had prior to the surgery.

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.

A much smaller group of 3% – 5% will experience more severe compensatory sweating. Severe compensatory sweating, will make those patients less satisfied. 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 who develop mild to moderator compensatory sweating say that they are not troubled by this extra perspiration and it is preferable to sweaty palms. On the other hand those patients who develop severe compensatory sweating will complain about this excessive extra sweating especially in hot humid weather or certain anxious situations. It is important to note compensatory sweating would be a side effect for anyone receiving ETS whether they had hyperhidrosis or not prior to the surgery.

Less common side effects for the ETS Procedure (Sweaty Palms):
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 which ETS was done or the method in which it was performed. Because of Dr. Reisfeld’s position against performing ETS specifically for people suffering from facial blushing or facial sweating less patients have had this procedure done.

Temporary Recurrence after the surgery:
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. 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. In contrast to this short lived recurrence the possibility of a partial or full recurrence of sweaty hands and feet is always a possibility but in a very small percentage of the cases. In different studies it has been shown that between 1-2% recurrence rate does exist but it should be emphasized that there is no difference between the method used to do the sympathectomy i.e. the excisional method, chemical, the burning method or clamping method do have the same recurrence rates which is between 1-2%. For much more in depth information on this please see our hyperhidrosis recurrence page.

This question of why recurrence is sometimes asked from previously operated patients or potential patients. Again I would like to reiterate that this is rare and not a result of one method vs. another. Unfortunately the exact physiological – anatomical explanation is not yet completely known. Hopefully with time more studies will shed light on the problem.

Surgeons doing the procedure for the wrong reasons:
Since about mid 90’s more ETS procedures have been done and obviously since the number of cases has gone up tremendously the number of cited side effects is on the rise as well. Unfortunately, conditions such as isolated axillary hyperhidrosis (sweaty armpits), isolated facial sweating and or facial blushing are not valid reasons to perform the ETS surgery. Those cases that were done for the above mentioned clinical manifestations suffer from a very high rate of side effects and dissatisfaction. The major lesson learned is that the cases should have never been done to begin with. Dr. Reisfeld is very vocal about his disagreement with surgeons who perform ETS for the above mentioned clinical presentations. Dr. Reisfeld often turns patients away who present with the above mentioned clinical conditions and strongly advises them against it.

Obesity
Potential patients who are overweight should be aware that they might get compensatory sweating somewhat easier than a person of normal weight. Obese patients should also bear in mind that it is more difficult or contra indicated. 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 contacting our office.

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