Q: What are the main risks of the procedure?

<ul> <li>Rebound Hyperhidrosis - is the most feared complication. It involves an increase in sweating in areas of the body not affected by the sympathectomy, such as the lower torso, front or back. It occurs in as many as 30 – 40% of patients, but for most of these patients, it is not troublesome and settles spontaneously. However, in 2% of patients, rebound sweating can be severe, occurring spontaneously on the lower torso.</li>   <li>Pneumothorax - or air around the lung may occur, but is rarely of any significance, and settles by itself. If the pneumothorax is large, it can cause breathlessness but can be easily managed.</li>   <li>Horner’s syndrome - is a complication which can occur if the sympathetic nerve supply to the eye is ablated. This results in drooping of the eyelid (ptosis) and constriction of the pupil. Fortunately, this is exceedingly rare, occurring in less than one in 1000 cases.</li>   <li>Gustatory sweating (facial sweating following meals) whilst eating - following meals, particularly spicy foods, occurs to some extent in 5 to 10% of patients. This is not bothersome for most people.</li>   <li>Bradycardia or slowing of the pulse - may occur but is rarely of any clinical significance. ETS has no impact on exercise tolerance.</li> </ul>

Question 1

What are the main risks of the procedure?

Accepted Answer

Rebound Hyperhidrosis - is the most feared complication. It involves an increase in sweating in areas of the body not affected by the sympathectomy, such as the lower torso, front or back. It occurs in as many as 30 – 40% of patients, but for most of these patients, it is not troublesome and settles spontaneously. However, in 2% of patients, rebound sweating can be severe, occurring spontaneously on the lower torso.
Pneumothorax - or air around the lung may occur, but is rarely of any significance, and settles by itself. If the pneumothorax is large, it can cause breathlessness but can be easily managed.
Horner’s syndrome - is a complication which can occur if the sympathetic nerve supply to the eye is ablated. This results in drooping of the eyelid (ptosis) and constriction of the pupil. Fortunately, this is exceedingly rare, occurring in less than one in 1000 cases.
Gustatory sweating (facial sweating following meals) whilst eating - following meals, particularly spicy foods, occurs to some extent in 5 to 10% of patients. This is not bothersome for most people.
Bradycardia or slowing of the pulse - may occur but is rarely of any clinical significance. ETS has no impact on exercise tolerance.

Question 2

How long will I need to stay in hospital?

Accepted Answer

Most patients stay overnight and are discharged the following morning. If the procedure is performed early in the day, patients may go home the same day, as long as a responsible adult is at home to care for the patient.

Question 3

How much time off work will I require?

Accepted Answer

We recommend a week off work, especially if the work is of a physical nature. Chest and back pain is common in the first week, and often requires anti-inflammatory medications such as Nurofen to control the pain. Having said that, a number of patients return to work earlier and seem to manage quite all right.

Question 4

How long after the procedure can I fly?

Accepted Answer

Most patients are fit to fly 3-4 days after the procedure.

Question 5

If I get rebound sweating, can it be treated?

Accepted Answer

In most cases, the rebound sweating does decrease with time, but this cannot be guaranteed for all. From a practical viewpoint, there is no surgical option for rebound sweating. Certain medications with anti-cholinergic properties (e.g. Ditropan) can be helpful in this setting.

Question 6

How is the ETS performed?

Accepted Answer

There are many ways of performing a sympathectomy, including cutting the nerve, clamping the nerve, excising or ablating the nerve. At NWV, we apply the ablation (by electro-cautery) method.

Question 7

In which hospitals is the procedure performed?

Accepted Answer

John Fawkner Hospital, 275 Moreland Road, Coburg 3058
Cabrini Hospital, 183 Wattletree Road, Malvern 3144
Jessie McPherson Hospital, 246 Clayton Road, Clayton 3168
Western Private Hospital, 1-9 Marion Street, Footscray VIC 3011

All hospitals have state of the Art facilities with first class nursing care.

Question 8

Will the ETS have any impact on my feet?

Accepted Answer

In two-thirds of patients, there is a significant improvement in the feet following a thoracic sympathectomy.

ETS Procedure for Sweaty Hands