Patient Information
Sympathectomy
This leaflet has been written to provide information about surgery to treat excessive sweating and persistent facial blushing (endoscopic transthoracic sympathectomy). We hope it answers some of the questions or concerns you may have. It is not intended to replace talking with medical or nursing staff.
What is an endoscopic transthoracic sympathectomy (ETS)?
An ETS, commonly known as a Sympathectomy, is a procedure to treat excessive sweating (hyperhidrosis) and persistent facial blushing (erythrophobia).
Sweating is a normal body function needed for the regulation of body temperature. For some people however sweat is produced in greater amounts than needed to keep a constant temperature. This can occur most commonly in the hands, feet and armpits and may be worse during hot weather, emotional stress or can often occur without any reason.
Persistent facial blushing can also occur and can also affect the neck and upper chest area. This can lead to the individual becoming bright red in response to a non or minimally embarrassing situation. Sometimes facial blushing and excessive facial sweating occur together.
The sympathetic chain of specialised nerves runs along each side of the spine. One controls functions on the right side of the body and the other on the left. Selectively destroying the parts of the sympathetic chain that supply the sweat glands to the face, armpits and hands can often cure or improve excessive sweating and facial blushing.
How is it done?
You will be given a general anaesthetic and therefore you will be asleep during the procedure. The surgeon makes 2 small incisions underneath the armpit of the side to be operated on. An instrument with a tiny camera at the end (endoscope), which transmits pictures to a screen in the theatre, is inserted through the incision to allow the surgeon to view inside the chest cavity. The sympathetic chain is then identified and depending on the location of the excessive sweating and blushing the correct part of the sympathetic chain is cut.
The instruments are then removed and the surgeon may insert a small tube called a chest drain to allow the lung to fully expand. The incision site is then closed, usually with dissolvable stitches. The procedure is then repeated for the other side.
Will I feel any pain or discomfort after the procedure?
You may feel slightly uncomfortable after the procedure but you will be given medication to help control this. If you are in any pain you should inform the staff.
How long does it take?
The procedure usually takes about an hour.
How do I prepare for the procedure?
You will usually come into hospital the day before the procedure. You may need to have blood tests, a chest x-ray, a heart tracing (ECG) and a breathing test. Staff on the ward will prepare you for theatre. You will be given an antiseptic wash to use to help prevent infection. You will be informed when to stop eating and drinking prior to your surgery.
Will it be successful?
This procedure is performed regularly in this hospital and is successful in improving excessive sweating and facial blushing in the majority of patients.
On the down side most patients complain of increased sweating in other places. While they may no longer experience sweating in the hands, face and armpits the body is redirecting the sweat to other areas. Most patients however feel this is acceptable and not as obvious as excessive sweating in the hands, face and armpits.
What are the benefits of having the procedure?
Many people feel self conscious as a result of excessive sweating or persistent facial blushing. It can lead to individuals withdrawing from social events or avoiding activities known to bring on symptoms.
Often patients report an improvement in their quality of life following surgery and feel confident performing everyday activities.
What are the risks involved?
As with any surgery there is a small risk of complications.
There is a small possibility of internal bleeding. This may require a much bigger incision to be made in the chest in order to access the area and stop the bleeding.
Inadvertently damaging the higher nerves along the sympathetic chain can result in drooping of the eyelids and enlarged pupils (Horner’s syndrome).
All the risks involved with the procedure will be discussed with you in more detail before you sign a consent form.
What can I expect after the procedure?
Following the procedure you will be taken to a recovery room in theatre where you will be monitored before returning to the ward. Once back on the ward staff will check your heart rate, blood pressure, oxygen level and wound sites. Any drains from the wound are usually removed the day after the procedure. Staff will inform you when you are able to eat and drink.
When can I resume normal activities?
You may be able to go home the following day.
You must not drive for 1 week and you should take about 1 week off work. You will be reviewed as an outpatient approximately 6 weeks after the procedure. This advice will be discussed with you in more detail before you go home and you will be given a discharge advice sheet.
What alternatives do I have?
You may choose not to have surgery.
Other methods of controlling excessive sweating include the use of deodorants and medication as can be prescribed by your GP.
Skin specialists may be able to help with Botox injections that work by blocking sweat production in the armpits.
Iontophoresis is a method of controlling excessive sweating in the hands by using a small electric current to induce electrical changes in the sweat glands. This then disrupts sweat production. It works by placing the affected areas in tap water and passing a small electric current through the skin.
Your doctor would be happy to discuss any alternative treatments if they are applicable to you.
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JCOV32/PALS
Publication date January 06
Review January 08