Simpatectomy – Definitive Treatment for Excessive Sweating: Risks and Care of the Patient

Surgery used for the treatment of hyperhidrosis.

Deep in the chest, a structure called the sympathetic chain of the nerve runs up and down along the spine. It is the part of the nervous system responsible for the fight or flight response.

During a sympathectomy, a surgeon cuts or holds this nerve chain. This prevents nerve signals from passing through it.

Why might I need a sympathectomy?

This procedure is used to treat a condition called hyperhidrosis or abnormally intense sweating on the palms of the hands, face, armpits, and sometimes the feet.

It is also used for facial flushing, some conditions of chronic pain and Raynaud’s phenomenon , a condition that leads to a deep sensitivity to cold temperatures and changes in skin color.

After a sympathectomy, the brain can not send signals to the affected areas to make them sweat, blush or react so much to the cold.

This permanent procedure is used as a last resort if other steps, such as antiperspirants or medications, have not worked.

What are the risks of this surgical procedure?

As with any surgery that requires anesthesia, the risks include breathing problems or reactions to medications used to help you relax during the procedure. Other possible risks include:

  • Bleeding
  • Infection
  • Pain
  • More sweating in other parts of the body
  • Stroke or heart attack during the procedure
  • Collapsed lung
  • Pneumonia
  • Need for prolonged time on a respirator
  • Injuries to nerves or blood vessels during surgery
  • Weakness in the arms
  • Burning sensation in the lower part of the arms
  • The surgery does not alleviate the problem.

Also the side effects of sympathectomy may include a decrease in blood pressure while standing, which can cause fainting. After sympathectomy in men, semen sometimes ejaculates in the bladder, which can affect fertility.

After a sympathectomy some people may experience chest pain with deep breathing.

This problem usually disappears in two weeks. They may also experience pneumothorax (air in the chest cavity).

Diagnosis and preparation

A reversible blockage of the affected nerve cell (ganglion) determines whether sympathectomy is needed. This procedure interrupts the nerve impulses when injecting the ganglion with a steroid and anesthesia.

If the blockage has a positive effect on pain and blood flow in the affected area, sympathectomy is probably helpful. The surgical procedure should be performed only if the conservative treatment has not been effective.

Conservative treatment includes avoiding exposure to stress and cold, and the use of physical therapy and medications.

Sympathectomy is more likely to be effective in relieving sympathetic dystrophy if it is done soon after the injury occurs. The greatest benefit of early surgery should be balanced with the time needed to promote spontaneous recovery and responses to more conservative treatments.

Patients should discuss the expected results and possible risks with their surgeons. They must inform their surgeons of all medications they are taking and provide a complete medical history.

Candidates for surgery should have good general health. To improve general health, a candidate for surgery may be asked to lose weight, stop smoking or consume alcohol, and sleep well and exercise.

Immediately before surgery, patients will not be allowed to eat or drink, and the surgical site will be cleaned and washed.

What happens during the surgery?

Before the surgery, you will be given medicine (anesthesia) so that you fall asleep. You will not feel or remember the procedure. The surgeon will make 2 to 3 small incisions (cuts) on one side of your chest below the armpit.

Then, your lung will temporarily collapse and move away to allow the surgeon to reach the nerve chain along your spine.

Then, the surgeon will insert a small video camera and surgical tools to see and maneuver the nerve chain. Next, the surgeon will cut or hold the nerve chain to the correct level, depending on its exact symptoms.

When finished, the surgeon will expand the lung again, remove the camera and instruments and sew the incision. Then the surgeon will repeat the procedure on his other side. All the surgery takes about an hour.

Talk to your health care provider about what you will experience during your sympathectomy.

What happens after the procedure?

After the procedure, you will be taken to the recovery room to observe it. Your recovery process will vary depending on the type of procedure performed and the type of anesthesia administered.

Incision sites will be checked frequently. Once your blood pressure, pulse and breathing remain stable, you will be taken to your hospital room.

Most people can go home the day after surgery. I should plan for someone to take him home.

You can resume your normal diet unless your doctor advises you differently.

You may feel pain for a week afterwards. Your doctor may suggest that you take over-the-counter or prescribed pain medications.

Ask your health care team how to keep the incisions clean. Avoid soaking in the bathtub or going for a swim for 2 weeks.

You can probably do your normal activities after surgery. But, you may need to take it easy at first. Without lifting heavy objects or strenuous exercises until your body has healed.

Most people can return to work in a week.

Be sure to take all of your medications as prescribed and to attend the follow-up visits scheduled by your health care provider.

Patient care

The surgeon informs the patient about the specific posterior care necessary for the technique used. Doppler ultrasound, a test that uses sound waves to measure blood flow, can help determine if sympathectomy has had a positive result.

Normal results

Studies show that sympathectomy relieves hyperhidrosis in more than 90% of cases and causalgia in up to 75% of cases.

Less invasive procedures cause very few scars. Most people stay in the hospital for less than a day and return to work in a week.

Rates of morbidity and mortality

In 30% of cases, surgery for hyperhidrosis can cause an increase in sweating in the chest. In 2% of cases, surgery can cause an increase in sweating in other areas, including an increase in facial sweating when eating.

Less frequent complications include Horner’s syndrome, a condition of the nervous system that causes the pupil of the eye to close, the eyelid to fall, and sweating to diminish on one side of the face.

Other rare complications are nasal blockage and pain in the nerves that supply the skin between the ribs. Mortality is extremely rare and usually attributable to low blood pressure.

Alternatives

Non-surgical treatments include physiotherapy, medications and avoiding stress and cold. These measures reduce or eliminate the probability of triggering a problem mediated by the sympathetic nervous system.