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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