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Friday 8.30am-4.30pm

Is Endoscopic Thoracic Sympathectomy (ETS) a safe treatment for hyperhidrosis?

Hyperhidrosis or excessive sweating can be a devastating condition

It can often cause much distress to individuals who find themselves in that situation. It is most likely to affect areas where the sweat glands are in greatest abundance; hands, underarms (axillae), feet, face and scalp.

With so much information readily available on the internet, it is often difficult to decide what is accurate and what is inaccurate.  In short, there is much misinformation on many topics, including hyperhidrosis and modalities of treatment such as sympathectomy.

What is hyperhidrosis?

Hyperhidrosis occurs as the sweat glands are being “driven” by the sympathetic nerves that supply them. It is normal to sweat. Indeed it is sometimes IMPORTANT to sweat. We sweat when we
get hot, either through exercise or when the temperature is high, to cool the body down. In addition, it is common for some people to break out in a sweat when under stress, a so-called sympathetic response.

Individuals with hyperhidrosis find themselves sweating even on a cool day, when under no stress. For some unknown reason, the body’s thermostat has been set incorrectly, and they find themselves sweating when they shouldn’t be sweating.

Individuals bothered by hyperhidrosis need to consider non-invasive, simple, conservative measures first. This could include choosing clothes that “breath”, spending time in cooler environments, using antiperspirants on a regular basis.  If these measures fail other treatment options are available.

Is ETS safe?

Like all forms of surgery, there are risks, especially in the hands of an inexperienced surgeon. My first word of advice is to seek out a surgeon with an abundance of experience in performing
this operation, as things can go horribly wrong in the hands of an inexperienced surgeon.

Sympathectomy, in my opinion, is the best treatment option for patients with palmar (hand) hyperhidrosis, and probably the only option for patients with troublesome facial blushing.  It
is the one procedure that offers a success rate as close to 100% as possible. There is, however, so much misinformation about ETS on the internet, it is no wonder some patients are uncomfortable about proceeding and choose to live with hyperhidrosis or facial blushing.

Without a doubt, the main complication of this procedure is rebound sweating, often called compensatory hyperhidrosis. The incidence of this complication varies tremendously in the literature, depending to some extent on how it is defined. Some studies say the incidence is less than 1%, whereas at the other extreme some say it occurs in all patients. In my own experience, rebound occurs in 30 to 40%, and fortunately, in most, it is not troublesome, however, in 2% rebound sweating can be severe. These patients find themselves sweating spontaneously on the torso, and many regret their decision to have had sympathectomy.

It is that group of patients (less than 2%) who are most likely to verbalise their opposition to the procedure.

This complication is far more likely to occur in patients for whom ETS was performed for armpit sweating or facial sweating, as compared to those undergoing the procedure for palmar (hand) sweating or facial blushing. It is for that reason I no longer offer ETS to patients with axillary sweating but rather MiraDry

Other complications of ETS include Horner’s Syndrome, which results in drooping of the eyelid. This is very rare (less than one in 1000). Chest complications such as pneumothorax (air in the chest)
can occur but is usually of no clinical significance and rarely requires treatment. Gustatory sweating, which is facial sweating after meals, usually spicy meals, does occur in up to 5% but is generally not troublesome.

I have noticed a few patients experience a very slight reduction in pulse rate, but this is never of any clinical significance and importantly does not impact upon exercise tolerance. Reports of sexual dysfunction, mood disorders, including dissociative states have nothing to do with ETS, and are more likely linked to the emotional disorder already present in the patient.

ETS from North Western Vascular

ETS is an excellent choice of treatment for patients with troublesome palmar hyperhidrosis and facial blushing.  I advise individuals to choose to a surgeon with a special interest in this field and extensive experience in performing sympathectomy.

Roger Bell

Vascular Surgeon & Hyperhidrosis Specialist

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Testimonials

I was driving home this morning feeling unimaginably happy. Choosing to have surgery was the best decision I’ve ever made. The first time I met you, I was overcome by how completely you understood what I was going through. I think what you do is unbelievably selfless and amazing. You have literally changed my life.

It isn’t even these major things that I am most grateful for. It is the much simpler things – going out to dinner without feelings of stress and anxiety, holding hands, getting my nails done… Read More

Before this operation, I wore gloves to job interviews, I skipped church to avoid the peace-be-with-yous as the thought of shaking someone’s hand made me cringe and my tops and dresses were always black to avoid stains from under my arms. This operation has changed my life forever, it has built my confidence up and has allowed me to take up new hobbies like dancing.

I just wanted to say a massive thank you to Mr Roger Bell and his team for allowing me to live my life sweat free… Read more

I was driving home this morning feeling unimaginably happy. Choosing to have surgery was the best decision I’ve ever made. The first time I met you, I was overcome by how completely you understood what I was going through. I think what you do is unbelievably selfless and amazing. You have literally changed my life.

It isn’t even these major things that I am most grateful for. It is the much simpler things – going out to dinner without feelings of stress and anxiety, holding hands, getting my nails done… Read More

Before this operation, I wore gloves to job interviews, I skipped church to avoid the peace-be-with-yous as the thought of shaking someone’s hand made me cringe and my tops and dresses were always black to avoid stains from under my arms. This operation has changed my life forever, it has built my confidence up and has allowed me to take up new hobbies like dancing.

I just wanted to say a massive thank you to Mr Roger Bell and his team for allowing me to live my life sweat free… Read more

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