No medical or surgical treatment is void of side effects. Obviously the sympathectomy has some and potential patients should know about them and discuss with the surgeon before proceeding with the procedure. The first one is compensatory sweating also known as reflex sweating or compensatory hydrosis. The patient will develop sweat on other parts of the body such as the lower legs, thighs, abdomen, or the back. The upper body from the chest and up will be dry. All patients will develop some degree of compensatory sweating. The majority on a level that will be tolerated. In most cases 93% to 94% the patients prefer the compensatory sweating to the original sweating. About 5% to 6% of the patients will develop severe compensatory sweating that will render those patients to be unhappy. With the changing of the sympathectomy level to T3-T4 statistically the number of patients who suffer from severe compensatory sweating has been reduced. Also the statement of dryness of the upper part of the body from the nipple line on up is true of the operation is done at the T2 level. Lowering the sympathectomy to the level T3 T4 will not produce as much dryness as compared to the T2 sympathectomy.
Medication can sometimes help with severe compensatory sweating. For those patients who had the clamping method done the clamps can be removed and give the patient a possibility of reversal. So far about 50% of the patients who underwent clamp removal showed improvement with regard to their side effects. The exact timing between application of the clamps and removal is not yet established but its thought to be effective within the first 6 months. This number is not etched in stone yet because there is a need for many more patients to get into a statistical pool so one can come with meaningful data. Those patients on whom the clamps were removed describe some return of upper body sweating and hence reduction in their compensatory sweating. For those patients who had the cutting method done nerve graft reversal will be needed if they decide to try to reverse their severe compensatory sweating.
Another side effect is gustatory sweating. Here the patient will develop facial sweating while eating spicy or sour foods. This happens to about 5% of the patients but the majority on a mild to moderate fashion. Also here the change of the sympathectomy level from T2 to T3-T4 showed a definite reduction in the number of cases suffering from gustatory sweating. The basic working theory is that by leaving the T2 in tact there is less interference with the sympathetic-parasympathetic balance. Severe cases can be treated with medicated roll-on or botox injections.
The horner’s syndrome or the droopy eye syndrome used to be more common when sympathectomy was done in an open fashion. The endoscopic approach almost eliminated this possibility.
Reduction in heart rate was described by a few patients. Here on heavy physical activity one can note a lowering of the heart rate under maximum physical activity. Here again the lowering of the sympathectomy level from T2 to T3/T4 level has shown that the changes in the heart rate in maximum activity is not as prominent.
There are other side affects which were described by patients such as tingling sensation and the upper arms, initial night sweating mild weight gain are temporary in nature and disappear after a short time. Few patients will describe loss of stamina and of hair loss. Those are not necessarily associated with the sympathectomy.
Hair loss was also described by a very small number of patients that had the ETS procedure done. The exact correlation is still not know however it is interesting that female patients who represent about 50% of ETS patients typically do not complain about this problem as much as their male counterparts. Male baldness is a much more common clinical presentation so we will need more scientific data to connect hair loss after sympathectomy. As to other side effects that you might have heard of or read about it is better to direct those questions to the surgeon who may be able to shed more light on those possible side effects.
It is suggested that any potential patient should talk with his or her surgeon before making any final decision with regard to surgery.