Hyperhidrosis Discussion Forums
ETS surgery is made out to be a safe procedure on most surgeons' websites with typical short-term dissatisfaction rates quoted as being less than 5 percent. From my years of experiences of having talked to or e-mailed a large number of patients along with reading other forums on the web regarding this subject, the dissatisfaction rate is significantly larger in the long run. In addition, the surgeons won't divulge or will downplay a number of key problems that often occur in the aftermath of the surgery:
Your body will lose its ability to sweat above the nipple line. Some surgeons conveniently forget to mention this, while others play it down as being nothing to worry about. How do you lose heat from your head after this happens? Are there any long term side effects? Many people have complained of a very dry face and dry scalp after surgery? Many people have major body temperature changes during times of stress as a result of an altered body "thermostat" that can not enable heat loss via sweating through the upper body after surgery (further exacerbated by the lack of heat loss via the palms). The palms and feet have most of the body's sweat glands in them, so stopping sweating at either place will almost always guarantee compensatory sweating elsewhere.
ETS reduces the resting heart rate in a fraction of patients -- this fraction has been listed anywhere from one tenth to well over 50 percent depending on which surgeon you listen to. In my opinion, you should assume your heart rate will fall. Although not dangerous, this is something to think about. Are you willing to mess with your heart rate to get rid of consistently sweaty palms? I would still say yes based on my terribly sweaty palms, but not everyone would. Some surgeons are now warning that if you are an athlete, ETS might reduce your peak performance due to this side effect.
ETS leads to compensatory sweating (CS) in almost 100 percent of patients according to a couple of surgeons' websites I have seen lately. In the past, they usually gave a figure of around 40-60 percent, but this has steadily increased as more and more patients have started getting CS a year or two after surgery and the surgeons have realized that the problem does not necessarily start the day after the surgery (especially if its fall or winter or spring at the time and the outdoor temperature does not allow a patient's CS to be at its maximum). For me the CS occurred in my feet of all places?! See below...
Your feet sweating can become much worse than before surgery. Most people with palmar hyperhidrosis also have plantar (feet) hyperhidrosis. Surgeons typically say that there is anywhere from a 50-95 percent (again depending on which of them you listen to) chance of a reduction in feet sweating after ETS for palmar sweating (i.e, a bonus benefit). The feet sweating will remain the same as before ETS in the remaining patients according to the surgeons. However, I have experienced significantly greater feet sweating post ETS and so have many others I have talked with or read about on hyperhidrosis forums. I haven't seen a single surgeon point out this possibility to date. Sweat signals to the feet also come from the lumbar sympathetic chain in your lower back, so it seems that in some patients, the lumbar sympathetic chain starts transmitting more sweat signals to the feet once palmar sweating has ceased as a result of the destruction of one or more thoracic ganglion(s). A lumbar sympathectomy can cause reverse ejaculation in men and urinary incontinence in women (among other side effects), so almost no sane surgeon offers this procedure for the purposes of curing feet sweating anymore.
You can get extremeley cold hands post ETS, and like some of the other side effects, this can show up a year or more after the surgery -- so conveniently doesn't show up in many surgeons' list of potential side effects (that are often based on surveys conducted in the immediate aftermath of the surgery). This is also why ETS is not performed to cure Raynaud's (cold hands) syndrome by many surgeons anymore, since initially warm hands post-ETS can become extremely cold a year or two down the road. According to the "pioneers" of the endoscopic method of sympathectomy, Goran Claes and Christopher Drott (who used to practice ETS in Sweden until they were banned as a result of several patient deaths and lawsuits from several hundred of their past patients), this severely cold hands side effect happened in 2 percent of their patients due to "increased sensitivity to surrounding catecholamines" -- hopefully I will find out whatever that means from these forums as I myself get these cold hands from time to time.
In a related side effect to the one just listed regarding cold hands, the body's thermoregulatory system or thermostat can get out of whack due to changes in sweating patterns and sympathetic innervation to the upper body after ETS. Many people have had significant problems with this side effect, although for the majority, it does not seem to be an issue or is only an issue on rare occasions.
After ETS, some patients (typically less than 5 percent in the case of ETS for palmar sweating according to most surgeons) experience a recurrence of their original symptoms. This recurrence is usually most common with regards to ETS for facial blushing, Raynaud's Syndrome and for other such non-hyperhidrosis related problems. In my own case, I had some right had sweating return a year or so after ETS while the left hand has always remained super dry. During intense exercise, my right hand can get very sweaty at times. It is unclear to the surgeons why this recurrence occurs, and some claim that there is no way a destroyed ganglion can regenerate, so the sweat signals must be transmitting via other pathways. Many patients need to get reoperated on if the recurrence is significant. I am not sure how the reoperation works if the destroyed ganglion has not regenerated and hope to hear from someone with this knowledge. Does the surgeon destroy other ganglions besides the dead T-2 in the event of recurrence?
The only side effects that surgeons have talked about honestly and have quoted consistent risk percentages for are Horner's Syndrome (droopy eyelids) and Gustatory Sweating. Gustatory sweating is major forehead sweating when eating or even smelling spicy food and can occur a year or two after ETS. Horner's Syndrome is very rare in the hands of an experienced surgeon. Patients who do get permanent Horner's Syndrome have had to get cosmetic surgery to improve their appearance. Gustatory Sweating occurs in anywhere from 10-20 percent of patients it seems, although it is unclear if this figure is higher in the long run.
Problems that can occur during surgery include pneumothorax, intercostal neuralgia and even death on rare occasions (it seems like around ten deaths that have occurred in Western countries during ETS surgeries have been reported in the media over the past decade). Pneumothorax is some level of lung collapse after the operation. Intercostal Neuralgia is local pain in the chest wall area. Persistent or severe pain is unusual.
There are a host of other side effects that some people have complained about that are possible due to ETS -- such as sensitivity to light, dizziness, blood pressure changes, dry scalp, hair loss etc... If enough people complain about a specific problem and at least a few surgeons verify the problem as a side effect of ETS (as has been the case for all the side effects I listed above), I can add the problem in the above list as I am sure the surgeons' will never do it on their deceptive websites. Otherwise, I am treating those rumored side effects as unrelated to ETS.
Curiously, people who have severe facial blushing also get the second thoracic ganglion destroyed just as most palmar and facial hyperhidrosis patients still do. It seems that significant types of upper body innervation arise from the thoracic cavity and its associated ganglions, especially T-1 and T-2. That is also why injury to the first thoracic ganglion (T-1 or stellate ganglion) during surgery can cause permanent droopy eyelids and dilated pupils in the form of Horner's Syndrome.
You, the desperate patient think that you are putting your body through what you might consider a quick 1-hour (half an hour each side) minor surgical procedure (albeit under general anaesthesia). However, this can very often lead to long-term turmoil on the internal networking of your body. After all, the sympathetic nerve chain was purposely placed in a location (by god or chance whatever you believe) where it can never be damaged like virtually all other components of your body. Obviously, humans can easily damage external parts of their bodies through physical injury. In addition, all internal organs such as the kidney, liver, lung, heart, brain can be damaged by diet, smoking, drinking, cancer and the like. However, to my knowledge, the sympathetic nervous system (or more specifically, thoracic ganglions) can NEVER be physically damaged without surgical intervention because they are deep inside the chest and made up in a rope like material that can't break. So now, before you go get the quick fix ETS surgery, keep all the above factors in mind and then go read the forums on this site.
Finally, you will notice that ALL commercial and ETS surgeons' websites undermine the value and effectiveness of alternative treatments, which is truly a shame. In addition, most surgeons do not do long-term follow ups of their patients, or else their success rates from performing ETS would be much lower than reported.
Having said all that, ETS is a last resort option that can be a very effective cure for your palmar (and facial if present at the same time) hyperhidrosis. However, I firmly believe that there is an extremely strong chance of curing the hyperhidrosis using one or a combination of the numerous alternative methods available that are outlined in this website and forums if you are persistent.
Check out the portion of the website where I discuss the evolution of and confusion regarding ETS techniques and the way surgeons have managed to personalize their own variety of ETS at times -- i.e., cutting different ganglions for hand sweating relative to other surgeons, emphasizing/de-emphasizing kuntz nerve search and destruction, controversy about cutting the ganglion above or below each level or completely cutting it, "microcutting" versus clamping versus electrocoagulation and on and on.