Home Operative Technique
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ETS is performed with you completely asleep under a general, endotracheal anesthesia. The surgeon enters the chest cavity though a 1/4 inch incision located under the armpit. A small amount of carbon dioxide (CO2) gas, which is harmless, is pumped into the chest cavity in order to push the lung aside. This allows the surgeon to see the sympathetic nerve chain located along the side of the back bone or spine. The surgeon will cut or clamp the nerve that is responsible for the underarm, face or hand sweating or facial blushing. After the surgery is completed, all the carbon dioxide gas is removed, the lung is released and the skin hole is closed with an absorbable suture that does not need to be removed. The procedure is repeated on the other side. The operation takes about 30 minutes to perform and the patient is awoken with only minimal discomfort. A routine chest Xray is performed to insure the lungs have fully inflated after the operation and before you leave the hospital.
 
WHAT TO EXPECT AFTER THE OPERATION
 
Most people go back to the hotel on the same afternoon as the surgery. You will feel somewhat tired and may have a slight pain the chest and upper part of the back at the level of the shoulder blades. Most patients resume work or light activity in 48 hours and return to active sports or vigorous activity in 7 days. A persistent, slight to moderate pain may be felt in the chest or upper back for the first few weeks. A few patients will experience a prolonged pain or numbness of the arm, but none have permanent paralysis or sensory losses of the hands. Since no stitches need to be removed, the scar is very small, resembling a mole.
 
The effect of the operation is immediately evident. Upon awakening from the anesthesia the hands are warm and dry. Stress will not induce the same embarrassing facial blushing. During the first weeks or months after surgery patients feel a tingling sensation much like preceding the sweating and blushing, but no sweat or blush appears. No surgical procedure is 100% successful, but long term follow up has found a greater than 98% relief of hand sweating, 95% relief of facial sweating, 85% for blushing and 70% relief of axillary sweating.
 
SIDE EFFECTS AND COMPLICATIONS
 
While any surgical procedure has some degree of risk associated with it, ETS is a safe procedure with minimal side effects. Very few complications have occurred.
 
  • COMPENSATORY SWEATING This is the most common side effect and occurs in ALL of patients. It is best described as periodic perspiration around the lower stomach, back or groin region. It is mild and is tolerated by most patients. In some patients, especially during physical exercise or stress, it is troubling. It usually, but not always, improves with time. Severe compensatory sweating occurs in 1-2% of patients and is the most common reason for regret of having the operation of those operated.
  • Gustatory sweating is sweating in the head and neck area that is induced by certain smells and tastes. A runny nose may be the noticed side effect. Few regard this as a major problem.
  • Horner's Syndrome is drooping of the eyelid, a small pupil and redness to the eye on the affected side of the face. It occurs in less than 1% of patients and in half of the patients corrects on its own. The eyesight is NOT affected. In rare cases of permanent Horner's syndrome, the drooping eyelid can be corrected with Plastic Surgery.
  • Postsympathetic Neuralgia is pain in the shoulder or upper arm after surgery that persists for a few weeks after surgery. Fortunately, symptoms resolved in 3 to 6 weeks in most all patients.
  • Recurrent Symptoms may return as soon as 3 months, even with an excellent operation. It is most often due to regeneration of the nerves.
  • Dry hands, especially during the first few months can be treated my moisturizing creams.
  • Increased temperature sensitivity with cold hands and feet is rarely reported.
  • Heart rate is reduced by 10% and few patients actually notice impaired physical performance.
  • Migraine headaches and trembling hands are improved in many patients. The following are surgical consequences which occur in less than 1% of patients. These general complications are not common, but can be treated or corrected. *You can have an adverse reaction to the anesthesia.
  • Bleeding can occur in the area of surgery. Blood transfusion not usually necessary.
  • Air leaks from the lung resulting in a collapsed lung that does not reexpand after surgery.
  • An infection in the operative site wound. *Lung infection, pus in the chest cavity or pneumonia.
  • Blood clots developing in the legs and spreading to the lungs known as Pulmonary Embolus.
  • Chest tubes may have to be placed into the chest cavity to remove the trapped air or blood that has collected after surgery.
  • Open the chest cavity and repair any injury or complication.
 
Your surgeon will make every effort to insure that you have a safe and successful surgery. If you have any questions, problems or confusion about the operation and the risks involved, you need to ask your surgeon or someone from the surgical office.