Potential Complications of ETS


Potential Complications of ETSAs with all surgical procedures, individual reactions to the operation will vary. Our aim is to fully inform you of all the complications that may arise, even though the majority of patients do not experience them.

Rebound hyperhidrosis involves a slight increase in sweating in areas of the body not affected by the sympathectomy. This occurs frequently in as many as 30 - 40% of patients. Some studies suggest the incidence is higher. For most patients this is not troublesome and settles spontaneously. However in 2-5% of patients, rebound sweating can be severe and disabling. In rare cases the rebound is so severe the patient regrets the operation. Unfortunately, it cannot be reversed with further surgery. Some patients, for example those with facial/scalp sweating and older patients are at greater risk. In most but not all, it usually settles with time. 

Pneumothorax or air around the lung may occur, but is usually of no significance. If however the pneumothorax is large treatment may be required. A tube can be inserted into the chest through one of the incisions to alleviate the problem. This is immediately effective and performed while asleep. In nearly all cases the tube can be removed the following day. This has little or no impact on the length of hospital stay.
Horner’s syndrome can occur if the sympathetic nerve supply to the eye is ablated. This results in constriction of the pupil, and some drooping of the upper eye lid (ptosis). Fortunately, this is rarely seen as the sympathetic nerves responsible for the eye reside in the stellate ganglion, which is usually not in the operative field.

Pleurisy may occur due to inflammation of the lining of the lung (pleura). This occurs commonly 2 or 3 days after the procedure. It is often perceived as a pulled muscle between the shoulder blades. It can sometimes causes severe pain, but is usually controlled with anti-inflammatories. It invariably settles spontaneously.
Dry hands! Although this is the aim for many patients, those undergoing sympathectomy for other causes such as facial blushing or axillary hyperhidrosis need to be warned of this. This problem is easily remedied with moisturisers.

Gustatory sweating involves facial sweating following meals, particular spicy foods. This occurs to some extent in 5 to 10% of patients.

Bradycardia or slowing of the pulse may occur but is never of any clinical significance.
Article by
Melbourne Vascular Surgeon