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. He takes the time to explain both the benefits and the risks associated with the procedure 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 from 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 described 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 preferable to the sweaty hands they had prior to the surgery. This means that patients who previously had the ETS procedure for reasons unrelated to sweating will have compensatory sweating as well. This demonstrates that compensatory sweating is a by-product of the operation and not necessarily of the hyperhidrosis condition itself.

Since compensatory sweating is the most common side effect, more should be known about it and what is being done to improve this side effect. Over the last several years, the clamping method procedure has created an improvement in regards to the possibility of reversal.

Recently, lowering the level of the clamps to the third and fourth ganglia has had some positive effects on compensatory sweating. This portion of the site will be updated as more information is discovered. 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 can affect the satisfaction of patients who had the procedure done. Severe compensatory sweating can be very troublesome, especially when it soaks through 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 moderate compensatory sweating say that they are not troubled by this extra perspiration. For them, it is preferable to sweaty palms.

On the other hand, those patients who develop severe compensatory sweating will complain about this excessive extra sweating. This is especially true in hot, humid weather, or certain anxious situations. It is important to note that compensatory sweating could be a side effect for anyone receiving ETS, regardless of whether they had hyperhidrosis or not prior to the surgery.

Less Common Side Effects After The ETS Procedure (Sweaty Palms):
Side effects, such as fatigue, hair loss, loss of concentration, scalp itchiness, weight gain, shortness of breath, and reduction of exercise ability were all mentioned in an anecdotal fashion by different patients. These effects did not appear in a large number of patients.

Not every side effect could be directly related to the sympathectomy, but overall these kinds of side effects have been noted by patients in the past. Any questions should be directed to the surgeon before making any decision about the operation.

At times, it is difficult to answer questions without knowledge of the previous surgery and how it was done. Since Dr. Reisfeld takes a 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. This is a short-lived phenomenon that might last for half a day. In contrast to this short lived recurrence is the possibility of a partial or full recurrence of sweaty hands and feet.

This is always a possibility, but only occurs in a very small percentage of cases. In different studies it has been shown that a 1-2% recurrence rate does exist, but it should be emphasized that there is no difference between the method used to do the sympathectomy. The excisional method, chemical, the burning method, or the clamping method have the same recurrence rates. For much more in depth information on this please see our hyperhidrosis recurrence page.

This question is sometimes posed by previous patients and potential patients alike. Unfortunately, the exact physiological and anatomical explanation is not yet known. Hopefully with time more studies will shed light on the problem.

Surgeons Doing The Procedure for The Wrong Reasons:
Since the mid 90’s, more ETS procedures have been done and the percentage of side effects has risen as a result. 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.

In these cases, the patients suffer from a very high rate of side effects and dissatisfaction. The major lesson learned is that these 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 conditions. Dr. Reisfeld often advises patients with these conditions to seek out alternative methods of treatment.

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 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.

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 as well, and usually 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 maximum heart rate after 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, a 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 maximum exercise. We observed a small decrease in resting heart rates 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 has been 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.

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 in regards to their vocation. As more information comes to light, expect updates on the 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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  1. Mark  July 24, 2018

    Hi, I recently had the ETS Surgery for palmar hyperhydrois. My hands did not sweat for the first few days after the surgery, but for the last two days (days 4 and 5) they started sweating again. I am also experiencing the compensatory sweating (trunk and legs primarily, along with no sweating at all above the nipple line). I expected the trunk and legs increased sweating, but not the complete stoppage to sweating above that to an extent. So I have two questions One, regarding the recurrence for the last two days of the hand sweating, this has obviously made me incredibly anxious. Can you confirm for me if this is somewhat normal, or if I should be concerned the procedure did not work? And two, the increased sweating in trunk and legs (which is not severe, but I also wouldn’t call it mild) I will deal with and expected, but I have read reports of people having serious problems since their head and upper chest no longer sweat (overheating in hot weather, inability to workout nearly as long as previous to ETS, etc.). Is this true and can you offer any advice for me? Thank you!

    • Center For Hyperhidrosis  July 24, 2018

      Hi Mark. The recurrent sweating after 3-4 days after the operation happens to about 30% of the patients. If it was dry for 3-4 days it should stop.
      With regard to the compensatory sweating it is too early to judge.
      If you want to discuss the issue further you can call at 310-557-3037. Thanks

  2. Nancy  July 23, 2018

    I had ETS in 1997, I was 46. I had only right side done.my hyperhidrosis is hands and feet. It only worked on face, hand, armpit on right side. When I excercise, all sweating is on left, my face as well. It looks strange. I wonder if by doing both sides, I would have more or same compensatory sweating, which I do experience. I was around 13 when hands were affected. I have excessive sweating mostly when humid out than any other time.sometimes I just overheat, which is very embarrassing.i read that this is hereditary, and that I could pass it on skipping a generation, neither of my children have it, I worry my grandchildren could? Could elevated eye pressure, glaucoma, be a side effect?

    • Center For Hyperhidrosis  July 23, 2018

      Hi Nancy. I do not have all the answers for you but I`ll try.
      With regard to the fact that your ETS was done only on one side explains the fact that you remaining symptoms on the side that was not done. The number of case where only 1 side was done is low so we do not have any ability to have a significant ability to compare.I believe that having one side done only may be a reason to have less compensatory sweating compared to both sides done.
      Yes Hyperhidrosis is a genetic issue but it can skip generations. The grand kids might be affected.
      I have no knowledge about Glaucoma and ETS. No studies were done as far as I know.
      I hope that I gave you some answers. If you live in the US you can call us at 310-557-3037. Thanks

  3. Kyle  March 15, 2018

    I have practically dripping hands at times and am a pretty heavy sweater elsewhere (feet, armpits, buttocks). If the surgery were performed on me and I had compensatory sweating, would it be to all those areas I listed or just a certain area? I don’t care about sweating other places but my hand sweating is unbearable.

    • Center For Hyperhidrosis  March 15, 2018

      Those patients with severe cases of hyperhidrosis and did not get any help with alternatives methods the ETS is a an acceptable solution. One has to remember that compensatory sweating will develop on those sites that you mentioned.
      in most of the cases the sweat in those sites is preferred to the sweaty hands.

  4. gabby  February 24, 2018

    I would really like this surgery done would you be able to recommend a doctor in London? I wish i could get it done by you but its not possible

    • Center For Hyperhidrosis  February 24, 2018

      I`m not familiar with a specific surgeon who performs the ETS procedure for excessive hand sweating. Also with regard to your question about compensatory seating this side effect is not age related. Every one who gets ETS will develop compensatory sweating to a certain degree.

  5. X  February 6, 2018

    Does ETS leads to more hyperhidrosis?

    • Center For Hyperhidrosis  February 7, 2018

      While WTS helps with excessive hand sweating in return the patients will develop compensatory sweating on other body parts such as the abdomen and back. In most of the cases it is tolerated by the patients. Preferred by the patients to their excessive hand sweating.

  6. Lisa  December 26, 2017

    I had the surgery for my palms in 2002, I am now 43 I am having issues of my arms going numb while sleeping and all over body ache could this be a side effect?

    • Center For Hyperhidrosis  December 26, 2017

      Hi Lisa. Where was your operation done? It is very unlikely to develop it after so many years.Usually side effects like this appear much sooner if at all after ETS for excessive sweaty hands.
      You can also call us at 310-557 3037 so you discuss the situation in more details. Thanks

  7. Charlotte  January 19, 2017


    I am due for the ETS procedure in two weeks. I am very active and run everyday, will I be unfit or unable to reach my fitness level again? I am 30 years old and cant stand my dripping hands anymore, but are scared to sacrifise my healthy fit lifestyle!!

    • Center For Hyperhidrosis  January 19, 2017

      Very active and athletic patients with severe hyperhidrosis who underwent ETS were able to go back to their activity. Discuss the issue carefully with your surgeon before you make the final decision.

  8. John  September 22, 2016

    I had the surgery with Dr. Reisfeld about 20 years ago at age of 18. Ironically I now work as a hand therapist. This would never have been possible had it not been for this surgery. I do have compensatory sweating but it is not too bad and nothing compared to having constant sweaty palms. Thanks Dr. Reisfeld!

    • Center For Hyperhidrosis  September 22, 2016

      Thanks for your comment. This is my experience with most of the patients who suffer from Hyperhidrosis.

  9. Daniel  July 27, 2016

    Hello I had a surgery for facial flushing like a year ago , but now i’ m having a lot side efects , my surgery was with clip I would like to know if I can remove the clips and be like I was before of the surgery .thanks

    • Center For Hyperhidrosis  July 27, 2016

      I do not recommend the ETS for facial blushing/flushing. In order to shed more light into this please call me at310-557-3037. Thanks

  10. David Salas  June 17, 2016


    My name is David. I am a patient of Dr. Reisfeld who went in to have ETS for sweaty palms. I had the surgery in 1997 at the age of 20. I had a recurrence a year later and Dr. Reisfeld did another surgery at no cost immediately. Fast forward to today. I am 39 years old and have not had any major issues. I have had the standard compensatory sweating (back, chest, legs, groin) particularly during hot days, when eating spicey foods or when anxious. This is minor compared to the sweaty palms. One other side effect I have is the lack of optimal heart rate during extreme exercise. Again, nothing that I would trade to have the sweaty palms back. I have been blessed to have met Dr. Reisfeld.

  11. Leigh Ann  June 13, 2016

    I had Endoscopic Thoracic Sympathectomy performed in 2007. I have compensatory sweating which I expected. About a year ago, I developed severe pain in my abdomen along the same level as where the operation was performed. Could the Sympathectomy cause nerve pain like this? I’ve gone through intensive medical studies and everything has checked out as normal. Anyone else having this problem?

    • Center For Hyperhidrosis  June 13, 2016

      It is somewhat difficult to answer your question. There are many more questions to be answered and this could be accomplished via a discussion with the surgeon. You can call a 310 557 3037 and hope fully an answer can be given. As for myself I never heard about what you`ve described.

  12. Mikey  April 20, 2016

    I had ets done for fb in Feb 2016 I’ve noticed my hands go very hot and feels strange as I’m not warm, also my feet can go very hot or very cold when my body is not hot or cold, I also noticed when I’m warm I still go really red in the face and I do still blush but not as bad should I be if I’ve had ets for fb?

    • Center For Hyperhidrosis  April 20, 2016

      As for myself I do not recommend ETS for facial blushing. I came to this conclusion many years ago and not only refusing to do it but also speak against it. Where was it done?

  13. Eliza  December 28, 2015

    I came to your office in 1999 for the ETS. So glad we found this solution for my embarrassing sweaty palm problem. I’ve had the side effects mentioned above but so worth it to be able to live without dripping hands. I’ve noticed over the years that the tips of my fingers quickly get painfully numb when out in the cold (not even very cold temperatures), even with multiple layers of gloves. Other people around me don’t seem to be affected. Have other patients experienced this?

    • Center For Hyperhidrosis  December 28, 2015

      The best way to discuss it is to call the office at 310-557-3037. Thanks

  14. cynthia  November 3, 2015

    I have been experiencing compensatory sweating in my back. I am very unhappy with this side effect as it seeps through my clothing. It is quite excessive, and it is very uncomfortable. I had the surgery to clamp my armpit sweat glands in March. 2015. When should I begin to look into alternatives, or reversal of the procedure? So far, it has not stopped, or shown signs of decreasing.
    What do I do?


    • Center For Hyperhidrosis  November 3, 2015

      As for myself I do not recommend ETS for isolated Axillary hyperhidrosis. If it was already done with the clamping method than talk with your surgeon about taking them out. The success is not guaranteed.

  15. Diana Whitlock (Still)  May 21, 2015

    Good morning!

    My name is Diana and a patient of Dr. Reisfeld in 1997 under the name of Diana Still; I was 39 years old. I am now 57 and am experiencing finger joint stiffness and slight swelling in the middle knuckles in both hands (mainly in my right hand) and swelling. It is hard to open jars with lids or to pull up my light weight bed cover. I have been to the dr and have had blood tests, x-rays and no signs of RA. Some osteoarthritis which is normal for my age. I was wondering if cutting the T-2 nerve could cause this type of side effect or if anyone has experienced the same? I have been extremely happy with my surgery. The only side effect I have is compensatory sweating when I am exercising (back, armpits, legs, groin) and when I have hot flashes; sometimes when I eat hot spicy food my forehead sweats but it’s very minimal. Thank you for your time.


    • Center For Hyperhidrosis  May 21, 2015

      Hi Diana. Was nice reading your note. The above mentioned side effect is not known as a side effect after doing endoscopic thoracic sympathectomy for hyperhidrosis. It seems more likely like arthritic joint pain that can come at your age group.The compensatory sweating that you describe is a typical side effect that all patients after ETS get. The vast majority of the patients have it on a mild to moderate fashion. Thanks again.