Endoscopic Thoracic Sympathectomy - General Risks and Controversy

General Risks and Controversy

No surgery is risk-free, and ETS has both the normal risks of surgery, such as bleeding and infection, and several specific risks, including permanent and unavoidable changes in nerve function. A number of patients, mostly young women, have died during this procedure. Bleeding during and following the operation may be significant in up to 5% of patients. Pneumothorax (collapsed lung) can occur (2% of patients).

Compensatory hyperhidrosis (sweating) is common over the long term, causing 1% to 2% patients in one review to regret having had the surgery. The rates of severe compensatory sweating vary widely between studies, ranging from as low as 1.2% and as high as 30.9% of patients. Of those patients that develop this side effect, about a quarter said it was major and disabling.

A severe possible consequence of thoracic sympathectomy is corposcindosis (split-body syndrome), in which the patient feels that he or she is living in two separate bodies, because sympathetic nerve function has been divided into two distinct regions, one dead, and the other hyperactive.

Additionally, the following side effects have all been reported by patients: Chronic muscular pain, numbness and weakness of the limbs, Horner Syndrome, anhidrosis, neuralgia, paraesthesia, fatigue and amotivationality, breathing difficulties, substantially diminished physiological/chemical reaction to internal and environmental experience (e.g. pleasure and pain/ perceptual stimuli), somatosensory malfunction, aberrant physiological reaction to stress and exertion etc., Reynaud’s disease caused by cold weather etc. (ironically a possible indication for surgery), reflex hyperhidrosis (or compensatory sweating as above), systemic thermoregulatory dysfunction (hyperthermia), altered/erratic blood pressure and circulation, defective fight or flight response system, loss of adrenaline, eczema and other skin conditions resulting from exceptionally dry skin, rhinitis, gustatory sweating (or Frey's syndrome, see above).

Some long-term adverse effects include:

• Ultrastructural Changes in the Cerebral Artery Wall Induced by Long-Term Sympathetic Denervation
• Sympathectomy eliminates the psychogalvanic reflex
• Cervical sympathectomy reduces the heterogeneity of oxygen saturation in small cerebrocortical veins
• Sympathetic denervation is one of the causes of Mönckeberg's sclerosis
• T2-3 sympathectomy suppressed baroreflex control of heart rate in the patients with palmar hyperhidrosis. We should note that baroreflex response for maintaining cardiovascular stability is suppressed in the patients who received the ETS.
• Exertional heat stroke.
• Morphofunctional changes in the myocardium following sympathectomy.

Other side effects are the inability to raise the heart rate sufficiently during exercise with instances requiring an artificial pacemaker after developing bradycardia being reported as a consequence of the surgery.

The Finnish Office for Health Care Technology Assessment concluded in a 400 page systematic review that Endoscopic Thoracic Sympathectomy is associated with an unusually high number of significant immediate and long-term adverse effects.

Quoting the Swedish National Board of Health and Welfare statement: "The method can give permanent side effects that in some cases will first become obvious only after some time. One of the side effects might be increased perspiration on different places on your body. Why and how this happens is still unknown. According to the research available about 25-75% of all patients can expect more or less serious perspiration on different places on their body, such as the trunk and groin area, this is Compensatory sweating".

In 2003, ETS was banned in its birthplace, Sweden, due to overwhelming complaints by disabled patients. In 2004, Taiwanese health authorities banned the procedure on patients under 20 years of age. In other countries it is a notoriously unregulated procedure.

The internet now features many websites run by surgeons extolling the benefits of ETS. However, there are also many websites run by disabled ETS victims who complain of severe adverse reactions leading to decreased ability to perform ones occupation and daily activities and a perceived lack of adequate informed consent. Several online discussion forums are dedicated to the subject of ETS surgery, where patient testimonials abound.