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COMPENSATORY SWEATING AFTER
ETS FOR HYPERHIDROSIS
Dr
Senior Consultant Surgeon
Minimal Access Surgery
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In New Delhi, India, Minimal Access Surgery, Minimally Invasive Surgery, Thoracoscopic Surgery, VATS ( Video Assisted Thoracic Surgery ), and ETS ( Endoscopic Thoracic Sympathectomy ) are terms used to describe the modality of procedure that is done to interrupt the sympathetic nerve chain as a treatment for Hyperhidrosis of face, palms and axilla ( arm pit ).
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All possible complications of general anesthesia, starting from pain at the site of needle prick to side effects of the drugs.
Pain at the site of puncture for surgery usually lasts for a couple of days, though some patients have had it for a month.
Wound infections very rarely
Horner's syndrome if T1 level is operated upon and is the supply to eyes and face.
Rib pain due to bruising during the process of destroying the accessory Kuntz nerves that lie over them. This pain again is temporary.
Injury to lung or blood vessels in the chest. This is now extremely rare due to the good optical visualization using latest technology equipment.
And finally :
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.
However very few patients are
actually troubled by it as the main problem of palm sweating is over and this to
them seems like an insignificant price to pay.
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 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. Luckily this is extremely rare.
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.
Chain picked below T2 Divided with cautery Nerve of Kuntz Skin cut glued together
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AUTHOR'S EXPERIENCE WITH COMPENSATORY SWEATING
In the authors experience of Thoracoscopic Surgery over 10 years, over 200 patients have undergone this procedure of which about 50 have had the treatment in the last 2 years ( probably because of increased information available on the net and easier net access in India ). Average age has been 25 years and 90% male patients. Most patients have been IT professionals ( this may be due to easier internet access for them ). So far the improvement of palm sweating has been 100% ( this figure however should not be seen as a guarantee by prospective patients as the world wide results are about 95%).
Compensatory sweating was seen in 40% patients but none have been troubled by it.( It is not possible to explain why the Indian patients are showing a lower incidence of this side effect compared to what has been seen elsewhere in other studies ). Also except for one case of moderate compensatory sweating, all others had mild symptoms only.
None of the 200 patients so far have regretted their decision to have the ETS.
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The author Dr Arun Prasad MS, FRCS is a senior laparoscopic surgeon at Apollo Hospital, New Delhi.
Also a teacher in Laparoscopic Surgery at Ethicon Institute of Surgical Education, Mumbai and Delhi.
He was a surgeon at Charing Cross Hospital and Medical School, London and a teacher in Laparoscopic Surgery at The Royal College of Surgeons, London.
He belongs to the world's first generation of Laparoscopic Surgeons and is a pioneer in this field.
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