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Thoracic Sympathectomy


Endoscopic Thoracic Sympathectomy (ETS) is a surgical procedure used to treat more severe cases of hyperhidrosis, when other treatments have failed to achieve satisfactory results.

Two small incisions are made on the side of your chest and an endoscope (essentially a camera on a flexible tube) is inserted into the chest cavity through one incision, with a surgical instrument inserted through the other.

Using the endoscope to view the area, the Sympathectomy is accomplished by dissecting the nerve tissue of the main sympathetic chain.

The clamping method most often used, also referred to as an "endoscopic sympathetic blockade" (ESB), makes use of minute titanium clamps applied around the nerve tissue, and was developed in an effort to make the procedure reversible. However, it has been found that any reversal must be performed within a few days after clamping for any real chance of success, and even then recovery may not be complete.

Endoscopic Thoracic Sympathectomy can be used to treat hyperhidrosis of the armpits, face and hands. It is generally not used for excessive sweating of the feet, as there is a chance of inducing impotence or other permanent sexual dysfunction, due to associated nerve damage.

Studies by ETS surgeons have claimed an initial satisfaction rate around 85-95% with at least 2%-19% regretting the surgery and up to 51% of the patients complaining about decreased quality of life. However, at least one study shows a satisfaction rate as low as 28.6.

Most patients report various adverse reactions as a result of the surgery. And, whilst the results of endoscopic thoracic sympathectomy might appear moderately successful in treating hyperhidrosis, there is a high risk of complications.

Along with the normal side effects of surgery, such as pain, bleeding and bruising, the most frequent post surgical complication is ‘compensatory hyperhidrosis’ – where excessive sweating in seen another part of the body as a result, most commonly the lower back or upper thighs.

There is also the potential surgical complication of a pneumothorax, where air becomes trapped between the lung and the internal chest wall, making breathing difficult and painful. Whilst this can be a life-threatening condition, if not too large it generally resolves over time with out further surgical intervention.

Other fairly common complications of endoscopic thoracic sympathectomy include:

         Rhinitis - inflammation of the nose and

         Gustatory sweating - sweating on the face and neck after eating food,

Rarer complications of endoscopic thoracic sympathectomy as a result of nerve damage include:

         Damage to the phrentic nerve. – Phrentic nerve damage can lead to long term shortness of breath, repair of the nerve during the surgery is also possible in some cases..

         Horner’s syndrome, - a condition that causes drooping of the eyelids.

Endoscopic thoracic sympathectomy remains a fairly controversial procedure; with advocates claiming high success rates and minimal complications when performed correctly, whilst opponents report huge variation in post operation satisfaction levels and poor consistency in the surgical procedure as a result of anatomical variations in the sympathetic nerve network between patients and personal preferences between doctors.

For may patients, the social restrictions the live under as a result of their condition, might well outweigh any risk or side-effect.



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