Sunday, July 29, 2012

"The literature does not support the claims that a lowered level of sympathetic ablation results in less compensatory hyperhidrosis"

Some ETS surgeons, particularly in the United States, claim that their version of ETS results in fewer side effects because they operate only at T4 (thoracic vertebrae level 4) on the Sympathetic Nervous System.

These ETS surgeons typically claim that sympathectomies for hyperhidrosis or facial blushing performed at the T2, T3 or T2 and T3 levels are more likely to result in side effects, in particular the common ETS side effect of compensatory sweating, aka compensatory hyperhidrosis.

Many ETS patients experience compensatory hyperhidrosis to varying degrees that affects mainly the trunk (back, chest, stomach) and sometimes the groin and legs. A significant number of ETS patients report that their compensatory sweating is so severe that the excessive sweating on their trunk (and often groin and legs) soaks through their clothing every day, leaving them professionaly and socially disabled, fatigued, and with much worse quality of life compared with their pre-surgery, localised hyperhidrosis condition.

Naturally, compensatory sweating is a much-feared side effect of ETS among prospective patients - unsurprisingly, none of us want to swap sweaty hands, a sweaty face/head, sweaty underarms or a blushing face for a dripping wet torso, groin and legs.

Aware of this fear among prospective patients, some ETS surgeons have been claiming for several years now, with no scientific basis, that by performing ETS at the T4 level only, the chance of compensatory sweating developing as a side effect is greatly reduced.

Well, researchers Kopelman and Hashmonai at Ha'emek Hospital in Afula, Israel, reviewed much of the published literature on ETS surgery to evaluate the validity of the claim that a lower level of sympathectomy, and other techniques such as limiting the extent of nerve ablation (aka limiting the number of nerve levels cut, cauterised or clamped), reduces the occurrence of compensatory sweating.

Their paper was published in the World Journal of Surgery in Nov. 2008, and their conclusion was that there was no validity for the claim. Their conclusion stated:

"The compiled results published so far in the literature do not support the claims that lowering the level of sympathetic ablation, using a method of ablation other than resection, or restricting the extent of sympathetic ablation for primary palmar hyperhidrosis result in less compensatory hyperhidrosis. In the future, standardization of the methods of retrieving and reporting data are necessary to allow such a comparison of data."

Link to the abstract of this study:

So what does this mean if you are considering ETS surgery and worried about the side effect of compensatory sweating?

If any surgeon tries to claim that their version of the surgery is less likely to cause side effects such as compensatory sweating, I encourage you to be wary of what is effectively marketing spin with no scientific basis. It is your (only) body and your health. Do your research: read about the Sympathetic Nervous System, talk to others who have had the surgery, and read the online testimonials of ETS patients. Note the wide range of levels (T2, T3, or T4, or combinations of) that patients who did and did not develop compensatory sweating (and other side effects) were operated on. In addition, note the different types of surgical method used for different patients when you read their testimonials - were their nerves cut, clamped or cauterised?

Do testimonials from different patients operated at different levels, using different methods, often mention side effects - sometimes severe, life-changing side effects?

Do patient testimonials support the claim of some ETS surgeons that one method of surgery is safer than another and guarantees specific results?

For example, I was cauterised at T2 only - a level that some ETS surgeons claim is associated with much greater risk of compensatory sweating if operated on. Yet I have never experienced any compensatory sweating in the 11 years since I had my surgery, but I know of others cut or cauterised at T2 only who have experienced everything from mild to severe compensatory sweating (and other adverse side effects). And I have read testimonials of at least two ETS patients clamped at T4 who experienced severe compensatory sweating.

Images of severe compensatory sweating, courtesy of an Italian ETS patient:

Sunday, July 22, 2012