Side Effects

Patients undergoing ETS have to be well aware of the side effects of the surgery. ETS should only be done after other less invasive modes of therapy have been explored.

The more common side effects of the surgery are:

1. Compensatory sweating

This is the most common side effect of ETS. About 70% of the patients who undergo the procedure would experience compensatory sweating. This is manifested by excessive sweating at the back, abdomen, thighs and legs. In a small number of patients, this is also accompanied by thermo-regulatory disturbances and over sensitivity of the body to hot and cold temperatures. Compensatory sweating is tolerated well by most patients; however, in a small percentage of the patients, it could be troublesome. In some individuals with compensatory sweating, Robinul has been effective in decreasing generalized body sweating. It is extremely important to perform the surgery on the sympathetic nerve at the appropriate level and with great surgical precision to decrease the chance of compensatory sweating. At the present time, it is theoretically possible to reverse the operation by removing the titanium clip if the compensatory sweating or other side effects appear to be problematic.


2. Horner’s Syndrome.

This is a condition characterized by droopy eyelids, constricted pupils, and absence of sweating in the face. It may occur following ETS, and is usually temporary. The incidence of Horner’s syndrome is about than 0.3%. None of Dr. Malekmehr’s patients have ever experienced this complication.


3. Gustatory sweating.

This is the sweating of the face while eating or smelling certain type of foods. This happens in a small number of patients following the operation, but usually does not appear to be a major problem.


4. Neuritis and neuralgia.

This is a nonspecific pain, which is experienced in the back between shoulder blades. It may occur in a very small number of patients, and is secondary to irritation of the nerve endings. This condition usually resolves spontaneously, and can be treated with non-steroidal anti-inflammatory drugs such as Motrin, and is rarely severe or permanent.


5. Brachial plexus injury

This is an extremely rare complication of ETS. It presents as weakness or paralysis of the upper extremities and is caused by an injury to the spinal nerves. It has been reported as a complication of ETS.


6. Decreased heart rate.

After ETS, many patients experience about 10% drop in their heart rate. In the majority of patient, this does not affect endurance and tolerance of exercise. Other effects of ETS on the heart have been beneficial on patients with certain heart arrhythmia such as long QT interval.


7. Dry facial skin

Many patients after ETS report dry skin in their face, neck, and scalp area. Treatment with moisturizing creams may be necessary after the operation. This condition can be beneficial if the patient suffers from hyperhidrosis of the face; however, it is rarely severe. The drying of the skin also improves acne in many patients.


8. Pneumothorax.

This is a condition where the lungs do not completely expand immediately after surgery. Very few patients experience this, and it usually resolves spontaneously.


9. Hemothorax.

This is a condition of bleeding into the chest cavity. This is extremely rare in experienced hands. If it does happen, it requires evacuation of the blood, and the condition usually resolve spontaneously.

Any surgery under anesthesia carries risks from anesthetics, and drug reactions in addition to possible local wound problems, which are all extremely rare with this minimally invasive technique for ETS.