Reversal of Thoracic Sympathectomy

A thoracic sympathectomy (ETS) procedure is performed for a condition called hyperhidrosis (excessive sweating), typically of the face (facial blushing), armpits, and/or palms. When antiperspirants and medications have failed, this minimally invasive surgical procedure can be effective. The surgery involves disrupting (usually by cutting or clipping) the sympathetic nerves on both sides of the body in the upper chest. The thoracic sympathetic nerves control sweat production in these areas of the body.

Although a thoracic sympathectomy can be effective at alleviating excessive sweating of the face, armpits, and palms, there may be side effects. Surgery can result in a side-effect called compensatory hyperhidrosis. When the body stops producing sweat in one area, such as the hands or underarms, it may compensate by increasing perspiration in other areas, like the chest, back, or legs.

Compensatory sweating can happen at varying degrees of intensity. In addition to compensatory sweating, other reported side effects of an ETS surgery include:

• Poor control of heart rate
• Dry eyes
• Gastrointestinal distress
• Emotional distress
• Sexual dysfunction
• Other problems related to the sympathetic nervous system

At least 10% (and probably more) will experience complications from this surgery. Fortunately, the Institute for Advanced Reconstruction is world renowned for our revolutionary nerve reconstruction procedures, which can reverse a thoracic sympathectomy that causes unwanted side effects. 

Although there are several descriptions of techniques, we perform nerve grafting using the sural nerve in the leg that is transplanted into the chest to restore continuity to the interrupted sympathetic nerves. We use a minimally invasive technique to facilitate recovery. The protocol we are following also includes the application of nerve growth factors to enhance the likelihood of recovery.

Before the procedure, the patient will be given instructions on how to prepare, including any medications to stop taking and fasting (not eating or drinking) for a certain period of time. The procedure is typically done under general anesthesia, which means that the patient will be put to sleep.

During the procedure, the surgeon will make an incision in the leg to access the sural nerve. The nerve will then be carefully dissected and a section will be removed. The grafted nerve will be sewn into place and the incision will be closed with sutures or staples. The procedure typically takes 2-4 hours to complete.

After the procedure, the patient will be taken to a recovery room to be monitored until the anesthesia wears off. The patient may experience some discomfort and swelling around the incision site, and the surgeon will provide instructions on how to manage these symptoms. The patient may also be given pain medication to help manage any discomfort. Most patients are able to return to their normal activities within a few weeks, although it may take several months for the full effects of the surgery to be seen.

A nerve reversal is a surgical procedure that carries the risks and side effects associated with any surgery, including infection, bleeding, and scarring. Additionally, there is a risk of nerve damage, either to the sural nerve that is being grafted or to the nerve that is being repaired. There is also the potential for chronic pain at the site of the donor nerve.

Other potential side effects may include:

• Numbness
• Tingling
• Altered sensations in the area supplied by the donor nerve.

These side effects may be temporary or permanent, depending on the specific circumstances of the surgery. It is important to discuss all potential risks and side effects with a surgeon before undergoing nerve grafting using the sural nerve.

Reverse endoscopic thoracic sympathectomy is not appropriate for all patients, and whether or not you are a candidate for RETS will depend on a number of factors, including the severity of your sweating, your overall health and medical history, and your goals for treatment.

To determine if you are a candidate for RETS, it is important to consult with a qualified medical professional who can assess your condition and provide you with more information about whether RETS is an appropriate option for you. They may also recommend other treatment options, such as medications or other procedures, depending on your specific situation.

You may not be a good candidate if you:

• Do not have severe excessive sweating
• Have not tried non-surgical treatment options
• Have pre-existing heart or respiratory conditions
• Have an active infection
• Have extremely low heart rate
• Are a smoker
• Had previous chest surgery

You don’t have to live with the side effects of hyperhidrosis surgery. Contact us today to find out if a reverse endoscopic thoracic sympathectomy procedure is right for you.