ETS surgery is considered a last resort treatment for hyperhidrosis. The procedure carries a high risk of serious complications and a high likelihood of developing sweating elsewhere on the body which is distressing and difficult to manage. Many people who have contacted us that have had this procedure regret having it done. NICE has published guidance on ETS surgery for hyperhidrosis.
The procedure requires a general anaesthetic. Through small incisions in the chest the lung is deflated and sympathetic nerve trunk supplying the area of skin to be addressed is identified using an endoscope. The nerve is then cut, ablated or clipped. Potentially, clipping the nerve allows removal to reverse the procedure but the damage caused by the initial procedure does not always mean the function will return.
The procedure itself is generally effective in reducing the sweating of the areas intended BUT a huge drawback is that patients who have had ETS surgery are likely to develop serious complications or side effects.
A variation on the procedure known as a lumbar sympathectomy treats the sympathetic nerves in the abdomen to treat plantar hyperhidrosis of the feet.
The procedure requires a general anaesthetic. Through small incisions in the chest the lung is deflated and sympathetic nerve trunk supplying the area of skin to be addressed is identified using an endoscope. The nerve is then cut, ablated or clipped. Potentially, clipping the nerve allows removal to reverse the procedure but the damage caused by the initial procedure does not always mean the function will return.
The procedure itself is generally effective in reducing the sweating of the areas intended BUT a huge drawback is that patients who have had ETS surgery are likely to develop serious complications or side effects.
A variation on the procedure known as a lumbar sympathectomy treats the sympathetic nerves in the abdomen to treat plantar hyperhidrosis of the feet.
complications and side-effects of sympathectomy surgery
The risks of sympathectomy surgery often outweigh the benefits for many people. Since the procedure is commonly done when people are young, some of the consequences will last a lifetime.
Compensatory sweating occurs in at least 50% and up to as many as 98% of people who have the procedure done. The sweating of the extremity is effectively transferred to the torso. Sweating of the chest, back, thighs, buttocks or groin occurs which is more difficult to manage than the original site of sweating. It can begin straight after procedure or can develop months later.
Compensatory sweating significantly affects the quality of life of any patient. Some people feel this is a price to pay for being able to work with their hands whilst others regret having the procedure done. There are many personal accounts online and you would be advised to read and reflect on these if you were contemplating sympathectomy surgery.
Other complications include:
- Pneumothorax or heamothorax: Air, blood or sometimes other fluids in the chest cavity preventing the lungs functioning properly which has to be drained.
- Horner's syndrome. Nerve damage that causes a drooping upper eyelid (ptosis), a constricted pupil (miosis) and decreased sweating on one side of the face.
- A slow heart rate (bradycardia) that may require a pacemaker.
- Gustatory sweating. Sweating on the face with the smell or taste of food.
- Sexual dysfunction in men can occur after lumbar sympathectomy to treat feet sweating.
Additionally, there are complications of any surgical procedure including bleeding, bruising, infection and those associated with a general anaesthetic.
Compensatory sweating occurs in at least 50% and up to as many as 98% of people who have the procedure done. The sweating of the extremity is effectively transferred to the torso. Sweating of the chest, back, thighs, buttocks or groin occurs which is more difficult to manage than the original site of sweating. It can begin straight after procedure or can develop months later.
Compensatory sweating significantly affects the quality of life of any patient. Some people feel this is a price to pay for being able to work with their hands whilst others regret having the procedure done. There are many personal accounts online and you would be advised to read and reflect on these if you were contemplating sympathectomy surgery.
Other complications include:
- Pneumothorax or heamothorax: Air, blood or sometimes other fluids in the chest cavity preventing the lungs functioning properly which has to be drained.
- Horner's syndrome. Nerve damage that causes a drooping upper eyelid (ptosis), a constricted pupil (miosis) and decreased sweating on one side of the face.
- A slow heart rate (bradycardia) that may require a pacemaker.
- Gustatory sweating. Sweating on the face with the smell or taste of food.
- Sexual dysfunction in men can occur after lumbar sympathectomy to treat feet sweating.
Additionally, there are complications of any surgical procedure including bleeding, bruising, infection and those associated with a general anaesthetic.
other surgical treatments
There are a number of localised procedures that are done by some surgeons to treat sweating of the underarms. The procedures are often developed by individual surgeons and can use various techniques including traditional surgery or lasers and sometimes combinations. The terms curettage, ablation or excision are often used and sometimes liposuction is used. These procedures are not suitable for other areas of the body because of the damage that would be caused to the other critical structures in the area.
The aim of any type of local surgery for sweating is to either remove or deliberately injure the sweat glands to stop them working.
Most procedures are done with a local anaesthetic, meaning you will be awake and the skin of your armpit numbed up.
There are only a relatively small number of doctors who perform such procedures and whilst some are available on the NHS, the majority are only available privately.
Local surgical procedures can be successful but don't work for everybody. There is very little research regarding their long-term success, patient satisfaction or quality of life.
Some doctors who have done such surgery are beginning to recommend miraDry which achieves asgood, if not better, results using microwaves.
The aim of any type of local surgery for sweating is to either remove or deliberately injure the sweat glands to stop them working.
Most procedures are done with a local anaesthetic, meaning you will be awake and the skin of your armpit numbed up.
There are only a relatively small number of doctors who perform such procedures and whilst some are available on the NHS, the majority are only available privately.
Local surgical procedures can be successful but don't work for everybody. There is very little research regarding their long-term success, patient satisfaction or quality of life.
Some doctors who have done such surgery are beginning to recommend miraDry which achieves asgood, if not better, results using microwaves.
