Endoscopic thoracic sympathectomy

This is a form of surgery used to treat excessive sweating (hyperhidrosis). It is usually performed on severe cases which have failed to respond to non-surgical treatment such as strong antiperspirants and iontophoresis.

There are two types of surgery available to treat excessive sweating: endoscopic thoracic sympathectomy and sweat gland suction.

This surgery is best suited to people with excessive sweating of the face, hands and armpits. It is not advisable for people with plantar hyperhidrosis (sweating of the feet) due to the risk of complications such as sexual dysfunction.

Do you need surgery?

Surgery is often considered a last resort, as something which is only undertaken when all other treatment options have failed. It is a serious decision to make and one that you need to consider very carefully.

Make sure that you weigh up the benefits and risks before proceeding. There are two options open to you if you decide to have surgery which is treatment on the NHS or at a private clinic. There are pros and cons to both of these options so spend some time researching them beforehand. Discuss them with another person and only make a decision when you are ready to do so.

NHS surgery for excessive sweating

If you choose to be treated on the NHS then you will have to be referred to a surgeon. Your GP will do this for you.

This means going on a waiting list and the length of time you are on this list varies from one surgeon to the next. Resources are finite in the NHS and treatment is allocated according to need. Unfortunately, surgery for excessive sweating such as endoscopic thoracic sympathectomy is not considered a high priority which means that you will have to wait, and possibly for some time, before undergoing surgery.

This does not mean that you are unable to have this surgery on the NHS. It is available for people with severe excessive sweating but it is lower down the list of priorities compared to other surgical procedures.

Private treatment for excessive sweating

Another option is to ‘go private’. This means finding a private clinic and a surgeon who is best suited to your needs. This is not cheap and the costs can soon add up so think about this before making any payment.

Do your homework beforehand. Draw up a list of suitable clinics and visit them in turn. Use the internet to find out more about suitable surgeons, their experience, and skill level and success rates.

Talk to others. Ask your GP for advice and/or speak to people at a hyperhidrosis support group. They will be able to recommend a surgeon and clinic.

Cost is an important factor but there are other equally important issues such as the standard of care at the clinic, the aftercare service and their duty of care to you the patient.

Make sure that you know what you are paying for. Ask for a breakdown of costs so that you know exactly what is included in the price and ask again until you are satisfied with the answer. If the clinic appears interested in your money or has a causal, unconcerned attitude then go elsewhere.

Consultation with the surgeon

Whatever option you choose you will have an initial consultation with the surgeon. This is where you get the chance to ask him/her questions and to decide whether surgery is appropriate.

The surgeon will ask you about your medical history as well as your condition. This enables him/her to decide if you are suitable for surgery. If you are not then he/she will suggest an alternative. This consultation is designed to put you at your ease so that you approach your surgery in a relaxed state of mind. The best candidates for this procedure are people over 18, who are fit and healthy with no existing medical conditions and are aware of the risks.

Questions to ask the surgeon

Here is a list of questions which you can take with you to the consultation. You may find it useful to make a note of the answers as it is easy to forget something during the meeting.

These questions can be asked to either an NHS or private surgeon. If you are choosing a private surgeon then ask about the cost and what this includes, and more importantly, what it excludes.

These can include:

• How should I prepare for this surgery?
• What do I need to bring with me on the day?
• How long will I be away from work?
• What are the risks of this surgery?
• How long will the surgery take?
• How much pain can I expect after surgery?
• How long does the recovery take?
• How many years experience do you have?
• How many of these operations do you perform each year?
• What are your success rates?
• What qualifications/accreditation do you have?
• What does the price include?
• Are there any extras not included in the price?
• What is the aftercare service?

Many of our other medical guides contain a section on what to ask the surgeon. Visit any of these within the medic8 portal to find out more about the initial consultation.

Endoscopic thoracic sympathectomy procedure

This procedure is performed using an endoscope: this means that the surgeon will insert a tube with a camera mounted at one end into your chest in order to have a detailed view of the affected area.

This surgery is performed as a day case and under a general anaesthetic.

The surgeon will make a couple of incisions on either side of your chest before inserting the endoscope. He or she will also deflate your lungs as a temporary measure so that he/she has access to the nerves that regulate sweating.

These nerves form part of a chain called the ‘thoracic sympathetic ganglion chain’which itself, is a part of the sympathetic nervous system. This chain is located alongside the spinal cord and passes signals from the brain to the sweat glands.

What the surgeon will do is remove a section of sympathetic nerve tissue which will reduce the amount of sweating. There are a variety of ways he/she can do this which include excision or clamping but the outcome is the same.

The method used will depend upon your surgeon’s experience and preferences.

He/she will re-inflate your lungs to their normal capacity, remove the endoscope and close the incision with stitches.

You may have to remain in the clinic or hospital overnight following your surgery. Painkillers will be given to help control any pain or discomfort and you will be expected to take these for a couple of weeks following your surgery.

You will be given an appointment for a check up.

Benefits of endoscopic thoracic sympathectomy

This surgery is very effective at treating excessive sweating of the hands and then the face but is not recommended for excess sweating of the feet (plantar hyperhidrosis).

Plus there are mixed results for excessive sweating of the armpits (axillary hyperhidrosis).

But overall, this is an effective form of treatment for hyperhidrosis.

Risks of endoscopic thoracic sympathectomy

All surgery has risks although these are very small. Endoscopic thoracic sympathectomy is no different and comes with a few side effects which you need to be aware of.

These include:

• Tingling or prickling sensations
• Infection
• Scarring
• Compensatory sweating (excessive sweating in other areas of the body).
• Gustatory sweating (sweating around the neck and face after eating).
• Rhinitis (inflammation of the nose)
• Damaged phrentic nerve (this nerve aids with breathing)
• Drooping eyelids
• Pneumothorax (trapped air between the layers of the lung)

Another risk is that of damage to the nerves which are connected to the genitals and control fertility especially in men. These nerves are located close to those which control sweating in the feet and there is a risk that they could be damaged during surgery thereby leading to impotence.

This is why this surgery is not advisable for people who suffer from excessive sweating of their feet.

Your surgeon will discuss these risks with you beforehand.