As in other surgical procedure possible complications are always on the mind of patient and surgeon alike. You might compare it to taking a commercial flight. Done all the time and very safe but always a very small risk of complications. The same is true of surgery but the safety factor is extremely high. Complications such as bleeding, injury to the lungs, infection, scar formation are there but it should again be emphasized extremely rare. Knowledge of the particular surgeon about the procedure plays a major role. In the past a complication by the name of Horner’s syndrome was recognized but since the vast majority of the surgeons who are doing the operation on a routine basis this possible complication was eliminated. The main reason for this is the fact that ETS is done at a lower level (ie T3 and not T2 level). The above mentioned complications are extremely rare.
Side Effects of Excessive Dry Hands were reported by a very low percentage of patients. Female patients do enjoy the possibility of using hand lotions which they could not do before the operation. Compensatory sweating on the other hand is one of the side effects that every patient is experiencing. The compensatory sweating translates itself when patients after ETS experience sweat on other parts of the body that before were not part of the excessive sweating / hyperhidrosis that the patient had. Most of the patients report an extra amount of sweating on the abdomen, back, thighs and lower legs (not the feet). The majority of patients will experience this type of side effect (compensatory sweating) on a mild to moderate basis which enables them to conduct a normal way of life. Patients prefer having dry hands over the compensatory sweating. 3-5% of the patients will report a high level of compensatory sweating which will make them somewhat unhappy. Most of the surgeons who perform the ETS operation on a routine basis use the clamping method whereby titanium clips are placed onto the sympathetic chain. The benefit of this approach is that it allows the possibility of reversal should the side effects such as compensatory sweating are too severe. Recent studies have shows an advantage of this method compared to other methods where reduction in the compensatory sweating happened after the clips were removed.
Gustatory sweating (previously 2-3% / now 0.2-0.3%) also used to be a possible side effect. In this situation spicy sour food used to trigger facial area sweating. Again here removing the level of ETS from T2 to T3 reduced this possible side effect in a significant manner.
Heart rate reduction: Used to be a rare side effect of ETS where the heart rate was reduced somewhat and not physiologically significant rate with the old methods of doing ETS at the T2 level. Again here lowering the level of the sympathectomy to the T3-T4 levels almost eliminated this possible side effect.
Overall the ETS and ELS procedures have developed into very safe procedures with minimal operative complications and minimized side effects.