Thoracic sympathectomy

Your sympathetic nervous system is a part of your autonomic nervous system that controls involuntary bodily functions such as breathing, heart rate and digestion. It is made up of a network of nerves that are responsible for a ‘fight-or-flight’ response when faced with a potential threat or stressful situation. Part of your sympathetic nervous system is known as the sympathetic chain — bundles of nerve fibres that run along either side of your spine from the base of your skull to your coccyx. The nerves in the thoracic part of the sympathetic chain control the sweat glands in your hands, face and armpits.

A thoracic sympathectomy is a surgical procedure to cut, clamp or cauterise these nerves. This is most commonly done to stop excessive sweating (hyperhidrosis). The procedure can also be used to treat facial flushing and some types of cardiac arrhythmias (irregular heartbeat) that are caused by problems with the same nerves.

Hyperhidrosis is the medical term for excessive sweating. The condition is common and is thought to affect 1 to 3% of people in the UK. People with hyperhidrosis sweat more than is needed to regulate their body temperature. It can affect different parts of your body and may occur when you wouldn’t normally sweat such as when you are cold, or at rest. Hyperhidrosis isn’t dangerous but it can cause emotional distress and embarrassment. Long-term hyperhidrosis can also lead to skin problems. 

What are the symptoms of hyperhidrosis?

 The main symptom of hyperhidrosis is excessive sweating. This can occur on your palms, underarms, hands, face and body. You may also experience extreme facial flushing (temporary reddening of your face).

Hyperhidrosis symptoms can be mild, moderate or severe. You may have symptoms all the time, or they may come and go.

Over time, excessive sweating caused by hyperhidrosis can lead to other symptoms such as skin irritation, itching, cracked or peeling skin and body odour. 

What causes hyperhidrosis?

It isn’t fully understood what causes hyperhidrosis. Normally, sweat is produced by your eccrine glands in response to heat, activity or strong emotions to cool you down and regulate your body temperature. In people with hyperhidrosis, the eccrine glands are overactive and produce sweat more often and when it isn’t needed.

There are two types of hyperhidrosis:

Primary focal hyperhidrosis

This is the most common type of hyperhidrosis and affects “focal” areas on the body such as the hands, feet or armpits, usually on both sides of your body. It usually starts in childhood or adolescence. The cause of hyperhidrosis isn’t clear, but it may be due to genetic factors.

Secondary generalised hyperhidrosis

This type of hyperhidrosis occurs secondary to something else such as an underlying health condition or as a side effect of medication. It may be caused by thyroid disease, menopause, Parkinson’s disease, or due to drugs including some painkillers, antidepressants and diabetes medications.

Your consultant will normally only recommend a thoracic sympathectomy when alternative treatments haven’t worked.

Alternative treatments for hyperhidrosis include:

• Prescription antiperspirants: These antiperspirants contain aluminium and are usually the first line of treatment used to treat hyperhidrosis 
• Botulinum toxin injections: Work by blocking signals from your brain to your sweat glands and reducing sweating 
• Prescription creams: Creams that contain the active ingredient glycopyrrolate may help hyperhidrosis affecting your face and head
• Oral anticholinergics: These are tablets that reduce sweating 
• Nerve-blocking medications: Work by blocking the chemicals that allow certain nerve connections which may reduce sweating 
• Antidepressants: may help to decrease sweating and reduce the anxiety that can make sweating worse
• Iontophoresis: During this treatment, a weak electrical current is passed through water to treat the affected areas

The cost of a private thoracic sympathectomy procedure will depend on a variety of factors, including which hospital and which consultant you choose. Call today to speak to our advisors and get a tailored quote.

Our fixed-price packages include the cost of your treatment and all appropriate aftercare appointments. However, any diagnostic tests and your consultant's outpatient appointment consultation fee are charged separately.

Our flexible payment options help you spread the cost of your payment across a time period that suits you. We offer fixed-term monthly payment plans over one to five years with no deposit required. If you decide to pay over 10 months, you will pay interest-free. If you are paying for a longer period, you will pay 9.9% APR.

If you have private health insurance, hyperhidrosis will usually be covered by your provider. Speak to your insurer directly to find out.

At your first appointment, you will be seen by a consultant specialising in conditions such as hyperhidrosis.

Your consultant will ask you about your symptoms, general health, medical history, and any medications you take regularly. They will ask you how your symptoms impact your life, your reasons for wanting to have a thoracic sympathectomy and what you hope to achieve from the treatment. They may perform a physical examination.

Your first appointment is important as it’s where you’ll meet your consultant, the doctor responsible for your care. Your consultant will spend time getting to know you, discuss your expectations for treatment and encourage you to ask any questions you may have. At Circle Health Group, we want you to be as well-informed and comfortable as possible during your hyperhidrosis treatment, so please discuss any questions or concerns with your consultant during your appointment. 

Will I need any tests or scans? 

In some cases, your consultant may order tests to measure how much you sweat or to check for other health problems that could be causing your symptoms.

These may include:

Starch Iodine Test

During this test, an iodine solution is applied to the affected area. When the iodine has dried, starch is sprinkled on top. The areas where you experience excessive sweating turn dark blue.

Vapometer

This is a device that measures the amount of sweat produced by your hands, feet, scalp and underarms. It allows your consultant to measure your sweat production before and after treatment and to check how effectively your treatment is working.

Blood test

To check for any underlying conditions that could be causing your hyperhidrosis.

How is hyperhidrosis diagnosed?

Your consultant will diagnose hyperhidrosis based on your symptoms, medical history, physical examination and the results of any tests.

Your consultant will tell you everything you need to do to prepare for your thoracic sympathectomy. Instructions on how to prepare will also be in your appointment letter. 
If there’s anything you’re not sure about, or if you have any questions, please contact the hospital for advice.

Pre-operative assessment 

Around a week or two before your surgery, you may need to attend the hospital for a pre-operative assessment to make sure you are fit for surgery. Take any medication you take regularly with you to your appointment. At the preoperative assessment, we will check your weight and blood pressure and order tests such as a blood test, chest X-ray, and electrocardiogram (ECG) to evaluate your general health.

Optimise your general health

It's important to be in the best possible health before your thoracic sympathectomy. This will allow your procedure to go as smoothly as possible, speed up your recovery and reduce the risk of any complications after your surgery.

To ensure you are as healthy as possible before your surgery:

• Stop smoking at least eight weeks before your procedure. Smoking increases the risk of complications such as breathing difficulties and infection and can impair wound healing. Your consultant can offer you advice and support with quitting smoking before your surgery
• Follow a healthy, nutritious diet
• Take regular exercise
• Avoid alcohol for a few days before and after your surgery. Alcohol thins your blood and can increase the risk of bleeding during your operation

Regular medications

Tell your consultant about any medications you take regularly, including over-the-counter medicines and supplements. You may need to stop taking certain medications, such as blood thinners for a few days before your surgery. This is to minimise the risk of bleeding during and after your procedure. Your consultant will advise you on which medications to stop taking and for how long.

The day of your surgery

On the day of your surgery, take a shower before you arrive at the hospital. Do not apply any products to your skin such as lotions, creams, makeup or perfume. Don’t wear nail polish or contact lenses on the day of your surgery. Leave any valuables and jewellery at home.

You will not be able to eat or drink anything from midnight on the day of your thoracic sympathectomy surgery.

Before your surgery, you’ll need to sign a consent form to say that you agree to have the procedure and are aware of what it entails and the possible risks and complications of the surgery.

Thoracic sympathectomy surgery is performed under general anaesthetic which means you’ll be asleep during the procedure and won’t feel any pain.

During your thoracic sympathectomy:

1. Once the anaesthetic has taken effect, your consultant will make two or three small incisions (cuts) under your arm 
2. Your consultant will then temporarily deflate your lung, which stops it from working during the procedure and gives them more space to work
3. Your consultant will insert a flexible tube with a camera (endoscope) into one of the incisions. The camera transmits video images from inside your chest to a screen allowing your consultant to locate the nerves that control sweating
4. Once located, your consultant will insert special surgical instruments through the other incisions and cut, clip or cauterise the nerves
5. Your lung is re-inflated, and the incisions are closed with stitches
6. If needed, the process is repeated on the other side 

Thoracic sympathectomy surgery usually takes between one and three hours.

Recovering from any type of surgery is a gradual process that is different for everyone. Recovering from a thoracic sympathectomy depends on several factors including your age, general health, the type of procedure you had and other factors personal to you. You can help your recovery to go more smoothly by being as well informed as possible about your surgery and recovery and following your consultant’s post-operative instructions carefully. Call the hospital if you have any questions or concerns.

After your thoracic sympathectomy, you’ll be taken to the recovery room where you will be monitored closely until the anaesthetic has worn off. You’ll then be taken to your room.

You may have tubes in your chest to drain any blood or fluid after your surgery. These will be removed after a day or two.

You may have some pain or discomfort for a week or two after your surgery. Your consultant can prescribe medication to manage this.

Your healthcare team will show you how to change your dressings and care for your surgical wound after you are discharged from hospital. They will also tell you when you can shower or bathe. Your surgical incisions will usually heal in around a week.

You may also be given breathing exercises to do at home.

After your thoracic sympathectomy, gradually build up your activity level by doing a little more each day. Stop if you have pain or feel tired. Most people resume normal daily activities within around a week. Avoid strenuous activity and heavy lifting for three to four weeks after your surgery. 

How many nights will I need to stay in hospital?

Will I be able to drive home?
You will not be able to drive yourself home from the hospital after your thoracic sympathectomy. Please make arrangements for someone to collect you, or we can organise a taxi if you prefer. 

How soon can I go back to work?

When can I drive? 
You can drive when you can safely control your vehicle and perform an emergency stop. Do not drive while you are taking strong pain medication or other medicines that may affect your concentration and impair your reaction times. Get the all-clear from your consultant before driving after your thoracic sympathectomy.

When will I be back to normal?

A thoracic sympathectomy is a generally safe procedure, but as with any type of surgery, there is a small risk that complications may occur.

Your consultant will explain all the possible risks and complications of thoracic sympathectomy before your procedure and answer any questions you may have. It’s important that you are fully informed about any possible risks and complications before your procedure and are able to make an informed decision. You can help minimise the risk of complications by following the instructions you are given on how to prepare for your procedure and what to do afterwards.

Possible complications of any type of surgery include:

• Adverse reactions to the anaesthetic
• Bleeding 
• Blood clots in the legs or lungs
• Wound infection
• Damage to nearby structures
• Chest infection

In addition to the above, possible complications of a thoracic sympathectomy include:

• Pneumothorax (a collection of air in your chest)
• Haemothorax (a collection of blood in your chest)
• Horner syndrome: a rare condition that causes drooping eyelids, and decreased facial sweating 
• Damage to other nerves, blood vessels or surrounding tissues 
• Compensatory sweating: you may start to sweat excessively in other parts of your body 
• Gustatory sweating: facial sweating when eating or smelling certain foods 
• Your palms may sweat temporarily after your surgery. This normally lasts around half a day 
• Slowing of your heartbeat 
• Surgery may be unsuccessful, or your symptoms may come back

At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about treatment for hyperhidrosis, book your appointment online today or call a member of our team directly.

Thoracic sympathectomy for hyperhidrosis: from surgical indications to clinical results - PubMed 

Endoscopic thoracic sympathectomy - Medline Plus  

Thoracoscopic sympathectomy (TES) - Manchester University NHS Foundation Trust 

Hyperhidrosis - Johns Hopkins Medicine