Dr Slobodan Mirosavljev
+381 64 17 05 947 slobodan777@yahoo.com

Dr. Giudiceandrea Alberto
+39 3333740186 agiudi@yahoo.com




How effective is surgery?

The effect of the operation is immediately evident. Upon awaking from the anestesia the hands are warm and dry. The effect on facial sweating and/or blushing will be noticed in stressful situations which previously usually would cause blushing. The results of the procedure has been investigated after several years and patient have been asked  to assess their symptoms on a scale from 0 to 10 where 0=no symptom at all and 10= the most severe symptom. The results after 5 years shows a reassuring 2 to 3

Who cannot have this surgery?

Those patients with previous chest surgery or significant pulmonary disease may not be candidates. Patients at risk for severe side effects should also not be operated

Should I have surgery?

That is an individual decision based upon how much Hyperhidrosis affects quality of life and understanding the risks and benefits of surgery. New surgical techniques have dramatically reduced the discomfort and healing time for those patients considering sympathectomy.

What are the risks of surgery?

Risks of surgery include infection, blood loss and injury to structures in the chest including the lung and nervous tissue. These complications are extremely rare, but not nil. The major neurological risk of the procedure is a Horners syndrome. Patients wit h a Horners syndrome will notice a lazy eyelid and a small pupiland impaired vision. This syndrome is caused by injury to the T-1 sympathetic nerves, located just above the T-2 ganglion and which innervate the eyelid muscles and pupil.

What are side effects of surgery?

Patients may experience compensatory sweating of the chest, abdomen, thighs and legs. This may occur in up to 80% of patients. 2% of these patients develop incapacitating Compensatory Sweating.

Clipping or cutting?

Clipping is safer than cutting because there is no dispersion of heat, which could damage the stellate Ganglion and cause Horner syndrom. The clip can also be removed in case of severe compensatory sweating or postoperative Horner

T2, T3 or T4?

This indicates the hight of the clipping or cutting, T2 stands for the second thoracic ganglion. The clipping in this case is done above and below the second ganglion or only above (to reduce trauma to the nerve). T2 sympathectomy is required by FB and facial sweating. T3 is useful by hand sweating and armpits sweating. As a rule the higher the sympatic trunk is interrupted more compensatory sweating is present, but rarer are recurrences. The height of the cut or clip should be discussed with the patient

Is ETS reversible?

Yes. ETS is reversible. If ETS is performed with a Clip (ESB), this can be removed by a similar endoscopic procedure. IF the sympathetic trunk has been cut or  gangliectomy or cauterisation of the chain has been performed a nerv transplant procedure is necessary. The sural nerve is harvested from the ankle region or form the intercostalspace and implanted in the gap between the two cut ends und secure by fibrin glue. This is done endoscopically.

How effective is a reversal? 

In case of ETS-C the clip can be removed and CS and the thermoregulatory function will improve but not return to the initial status. The chances of succsess are higher if the clip is removed soon after surgery. In case of nerve transplant the jury is still out, there are no serious  statistics available,  but there is a growing body of anecdotal evidence suggesting a partial improvment after reconstruction

How do you treat Horner-syndrome:

2/3 of Horner-syndromes improve without treatment after 5-6 months. The rest need corrective surgery of the Eyelid. Results are not always satisfactory.

What is the problem with ETS?

ETS is a very effective way to treat hyperhidrosis and FB in the vast majority of the cases, but  a small group of patients have devastating effects. Unfortunately, we do not know who  these patients are before we operate. There is some evidence that this patients are muscular or obese (BMI >30), older, male  and on medication and have T2 sympathectomies.. There is no resarch at all on this subject and no scientific sound  evidence is available.   More research is needed. The extent of surgery is  also a very important factor: less invasive the surgery, less side effects. Extensive surgery or burning causesnerve scaring, which may behave like epilepsy of the autonomous nervous system and cause the well known devastating side effects.