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POST-SURGERY CONSIDERATIONS
Following an ETS procedure (sympathectomy surgery), most patients leave the surgical center about an hour after the operation. Patients who are accompanied by a friend or a family member may leave the hospital after the operation. Returning to work is up to each individual patient. Light-duty work may be resumed four or five days after the procedure.
Phantom Sweating
Before surgery, most patients report that prior to the onset of their sweating, they felt a tingling sensation in their hands. After the operation, patients have commented that they still sense the tingling sensation in hands or face and fear the operation was not successful. However, no sweating recurs. After a while, the awareness of any phantom tingling or pre-sweating sensation fades
Pleuritis and Neuritis
Pleuritis is a condition where the chest wall lining (pleura) is inflamed. It may cause a stabbing-like pain one to two weeks after an ETS or ETB. Neuritis, which is pain between the shoulder blades, may develop in a small percentage of patients. This discomfort is due to inflammation of the underlying nerves. In rare cases, it may be severe and possibly last two to three weeks. Treatment consists of steroids and non-steroidal anti-inflammatory agents.
Neuritis is a condition of inflammation involving the underlying nerves. Either condition may occur after surgery. Medications are given to help prevent or reduce the discomfort of these symptoms should they occur.
Dry Hands
After surgery, a patient's hands will be very dry. Frequently, hand lotion is necessary to keep the skin soft. Since most people with hyperhidrosis have not had problems with dry skin, this can be a surprising result. It is important for patients to keep their hands moist with lotion.
Emotional Relief
Following the surgery, the burden and embarrassment of severe sweating vanishes. Most patients feel a profound emotional experience as soon as they wake up from the anesthesia. Nearly half of all patients wake up crying with joy in the recovery room. Only someone who has suffered from the physical and emotional symptoms of hyperhidrosis can truly understand this reaction.
It usually takes about one to two weeks for a patient to develop confidence that he or she will no longer sweat.
POSSIBLE SIDE EFFECTS
As with all surgical procedures, there are certain side effects and risks associated with an ETS. However, when this procedure is performed by a skilled endoscopic surgeon with extensive experience with this treatment, the incidence of complications is low.
Compensatory Hyperhidrosis
Compensatory sweating (CS) is the most common, expected and significant side effect of an ETS. CS is reported to occur in 100 percent of patients who undergo sympathectomy for hyperhidrosis. It occurs regardless of whether the procedure is an open or endoscopic procedure.
Compensatory hyperhidrosis is a condition where the heat loss or sweating is shifted from the hands, armpits, face and scalp to the upper and lower back, lower chest, abdomen, buttocks, groin and backs of the thighs. The brain transfers the sweat to a different location in order to get rid the body of excess heat. The severity of the CS depends upon the levels of the sympathetic chain that are interrupted.
Some mild to moderate sweating occurs in all cases following an ETS procedure and is usually tolerable. The symptoms of CS may occur intermittently or be constant throughout the day. What matters is the severity of the syndrome. Mild CS creates moisture on the trunk, buttocks, groin or legs, but does not penetrate through clothing. Moderate CS involves moisture in the same areas, but does show through clothes. Most people tolerate it or may use some medications so that the CS diminishes.
Severe CS causes profuse sweating between the breast, below the breasts to the lower chest, abdomen, upper and lower back, groin, buttocks and the backs of the thighs and knees. The sweat stains the shirts and pants. Sweat stains are left on chairs and sofas. Patients may feel cold or hot and just plain miserable. Those patients who develop severe CS may feel that this side effect is worse than their previous hyperhidrosis and express regret regarding their sympathectomy.
Currently, it is not possible to accurately determine who will develop the severe form of compensatory hyperhidrosis after any ETS procedure. However, the sweating pattern prior to a sympathectomy often determines the sweating pattern after the operation. Persons who sweat only on the hands, feet and underarms, but not on the trunk, groin or legs often develop mild CS after a T2, T3 or T4 sympathectomy. It is not possible to guarantee who will develop severe compensatory sweating after any type of sympathectomy.
The compensatory hyperhidrosis may occur soon after the operation or many years later. Again, most people can tolerate mild or moderate compensatory hyperhidrosis as long as their hands or underarms no longer drip with sweat. There is no guarantee that severe compensatory sweating can be completely prevented.
It is impossible to determine in advance those who will develop the severe form of compensatory sweating.
Gustatory Sweating
This condition causes facial sweating after eating or smelling foods. People describe it as similar to facial sweating that follows after eating hot spicy foods such as chili. This condition occurs in about 10 percent of all patients who undergo a T2 sympathectomy.
Decreased Heart Rate
Among patients who undergo a T2 sympathectomy, approximately one of 10 will experience a 10 percent decrease in their resting heart rate. This decrease does not occur after a T3 or T4 sympathectomy. Dr. Garza recommends against performing a T2 sympathectomy on athletes as a T2 sympathectomy may impair his or her physical performance. Athletes should avoid a T2 sympathectomy.
Dry Facial Skin
Dry facial skin and an improved complexion may occur following an ETS or ETB. The dryness is rarely severe and patients seldom require a facial skin moisturizer. An unexpected benefit from the sympathectomy is that any acne complexion problems usually clear up within the first week after the operation. Most patients who had previous complexion problems are able to stop taking Accutane® after the procedure.
Dandruff
In some cases, patients may develop dandruff after the procedure.
POSSIBLE COMPLICATIONS
Horner's Syndrome
Horner's Syndrome is ptosis (a droopy eyelid), meiosis (a constricted pupil) and anhydrosis (absence of sweating). The patient may also develop nasal congestion. Horner's Syndrome results from the injury of the Stellate ganglion, or first thoracic (T1) sympathetic nerve. This condition may occur following an ETS or ETB and may be temporary or permanent.
Brachial Plexus Injury
The Brachial Plexus is a maze of nerves that radiates from the neck spine and travels down the shoulder to the arms. Injury to the spinal nerve roots may cause pain, muscle weakness or paralysis in the arm and hand. Treatment of this syndrome is extremely difficult.
Fortunately, this is a very rare condition, and Dr. Garza has never had a patient who experienced this complication. Occasionally, some discomfort in the inner arm for a brief period is felt in a small number of patients.
Hemothorax
This is a condition where bleeding occurs in the chest cavity. This is generally due to bleeding from a small artery that runs underneath the ribs. It is treated by chest tube drainage. This condition happens in less than one percent of all patients.
Pneumothorax
Pneumothorax is a condition in which the lung does not fully expand. This condition occurs in about one percent of all patients and may become an issue if the patient has severe lung problems such as emphysema. Chest tube insertions may be required if Dr. Garza has to cut across old scars in the chest from previous pneumonias or from a prior operation. A chest tube is usually inserted as a precautionary procedure.
Post Operative Rib Pain
Occasionally, there is pain between the ribs at the site where the endoscope was inserted. A sensory nerve runs below each rib. Compression of this sensory nerve by the endoscope may cause this problem. This usually resolves on its own in a short time. Rarely is this is a continuing problem.
About 20 percent of patients may develop a feeling of strong pressure-like sensation on their breastbone immediately after the operation. This is due to bruising of the intercostal (under the ribs) nerve when the endoscope was introduced between the ribs. Patients report that it "feels like someone is standing on my chest and I can't breathe." If one does develop this sensation, it usually abates after the first hour and rapidly fades away.
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Copyright © 1998-2004 The Hyperhidrosis Center. All rights reserved.
Medical Disclaimer: Please Read
Please remember that medical information provided by Dr. Jim Garza, in the absence of a visit with a health care professional, must be considered as an educational service only. The information sent through e-mail should not be relied upon as a medical consultation. This mechanism is not designed to replace a physician's
independent judgment about the appropriateness or risks of a procedure for a given patient. We will do our best to provide you with information that will help you make your own health care decisions.
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