Is T4 sympathectomy (ETS) a ''better surgery'' for treating palmar sweat?

tiago1995

Active member
As a palmar hyperhidrosis sufferer I've been looking into different cures for this condition for a reasonable amount of time now, even though I'm only 20 years of age and my sweating is relatively moderate (my hands never get to that dripping stage). Nonetheless, I've already visited two different thoracic surgeons in my area due to the fact that my mom kept insisting that I got the ETS (or VATS) surgery while I was a teenager. Instead of doing that though I preferred to steer away from the surgery for the time being and read everything that's on the web about it and its permanent side effects, and therefore to this day I'm very much skeptic and a bit scared to get it done on me.

Thing is, something popped up in my recent reads about ETS that caught my attention quite a bit - a few studies claim that if the surgery is done by cutting only the T4 level of the sympathetic trunk, while avoiding damage to the other nerves that lie above it (which are so frequently cut as well), the compensatory sweating side effects that arise post-op are minimized so significantly that in some of these studies virtually not a single patient said they were dissatisfied with the surgery at 6-month and one year follow-ups. And there's no apparent explanation as to why surgeons never thought they could solve the palmar/axillary problem by simply targeting this single nerve with minimized side-effects before (to this date some surgeons still cut T2 among other nerves causing the most severe forms CH).

What really surprises me here is that, if the results of those findings are really true and accurate, how can it be that this hasn't been regarded as a breakthrough in sympathetic surgery for palmar/axillary sweating? Why would so many doctors all over the world insist in perfoming the surgery the old-fashioned way, causing so much suffering in people who did not have to experience all the side effects?

ps. Sorry for my non-perfect English, it's my second language.

The links for the studies I've read are below:
Is sympathectomy at T4 level better than at T3 level for treating palmar hyperhidrosis? - PubMed - NCBI
T4 sympathectomy for palmar hyperhidrosis: looking for the right operation. - PubMed - NCBI
http://osp.mans.edu.eg/tmahdy/papers_of_month/0904_T4 sympathectomy for palmar.pdf

(I think I've looked at more of these sites but can't get hold of all of them).

I would love if somebody here could enlighten me on this matter... Cheers to everyone on here :)
 

Sprawling

Well-known member
Looks like you have been doing your research. You will find a lot of info on the back posts to help answer your questions. Unfortunately the SEARCH bar above does not always work sufficiently.

Personally I have opted out of having ETS. I've been doing ionto treatments instead for the past 10 years. It's a lot safer and not worth the risks.

Thank you for posting your findings.
 

JR25

Active member
Hi. Well done for doing some great research into surgery – research is extremely important for this I believe.
I’m not sure what nerves the surgeon cut when I had the surgeries, but one thing I will say is that 6-month and one year follow-ups do not give much information in my opinion. This is because sometimes the side-effects do not become noticeable until several years later (this was the case for me certainly). Therefore, a patient may feel after 6 months that they are doing great and have no side-effects, but unfortunately there is always a chance that a side-effect/s might start a year or two later.
My belief is that surgery should never be considered for this condition. Yes hyperhidrosis of the hands, feet, underarms etc is very distressing, but our nervous system is a very precious and vital system – every nerve is there for a reason (I believe), and it should be protected as much as possible. Once damage is done, it is very often not repairable.
Please think very carefully, and best of luck with whatever you decide to do.

JR25
 

SweatyCanuck

Well-known member
Mine was done at T3-T4. My compensatory sweating is out of control, as soon as I feel slightly warm my back, stomach, groin and legs explode into sweat - and I mean explode, it drips. I don't think CS is something you can predict. Yes there are a lot of us that are negatively affected by it and you can read tons of horror stories online... however, there are probably just as many or more who don't experience it - you just don't hear of it because they probably don't feel the need to post online about it if its not an issue. If you only have a problem in your hands and they don't drip I would say don't do it. You could end up with a worse problem. My hands DID drip and it was quite embarrassing and affected me in the workplace as well as socially. I thought it was the worst thing in the world till I had ETS. Now that my shirt and pants are constantly soaked through I sure wish I had my dripping hands back. But to put a positive spin on it my ETS only bothers me once the weather warms up. Most of the fall and winter I am dry unless exerting myself - something that my palms were not affected by at all... they would sweat even if it was -30.
 

Sprawling

Well-known member
I've been a sweater for 56 years. I chose not to have the surgery seeing how easily annything can make me sweat. It wasn't till 2005 that I found a forum that helped change my life. Prior to that I thought I was all alone with HH. I'm sure there are many people who had the surgery, yet never thought of looking online for a place to talk about it.

Statistically probably 100% of the people have some sort of compensatory sweating. It's a matter of the severity. When it's summertime and and my butt and groin are dripping I roll on the Aluminium chloride product. Guess what? I get compensatory sweating elsewhere and I never had ETS. My decision not to have the surgery was based on my body dynamics. It scared the crap out of me thinking I could swear more than I do already. Ionto was my magic bullet for my hands... except for the times it stopped working about 50%.

As mentioned above, the honeymoon stage can last 5 years before your body really goes out of kilter with compensatory sweating amongst other issues. Just more of my 2 cents worth of comments.
 

alwayswet

Member
When I was about 22 years old I started excessive sweating on the face/head. I looked like I had run a marathon when I only walked down a flight of stairs or walked to class. It really affected me psychologically to the point where I started drinking heavily. For some reason when I was buzzed I was more relaxed and I didn't sweat as bad. The only problem was that you can't stay buzzed all the time.

After college and working for 8 years, I slacked off on the drinking and tried the various cremes, heavy duty anti-perspirants (that stung the hell out of my face and caused rashes), and eventually ended up on anti anxiety medication that made me lethargic and killed any sexual desire. I was sober but I was still dripping. I was ready to jump off a cliff or eat a bullet.

I had the ETS done and life was grand. I walked down Miami Beach in June and didn't sweat a drop. After 6 months went by all of a sudden my back started sweating like crazy, then a few months later my back and my legs. I sweat through t-shirts and pants. Now just about everywhere below my chest gushes winter or summer. It sucks!

Even with the anti anxiety/depression medications I have let this condition eat at me to the point I dread just about everything except sleep. I am constantly dreading/avoiding any type of social activity and always wear dark clothes to hide the sweat stains. I use Odoban on my sides and below my chest, but it just makes me sweat more everywhere else.

If I had to do it over again, and given the options were the same I would have still chosen the ETS. At least now I can workout without sweat rolling in my eyes. Had I not had the surgery done, the upper half of my shirt and hair would still be wet. Now the bottom half is wet. Pick your poison.
 
I had ETS done when I was 14 years old. I think it was probably for the best, even though I have compensatory sweating..it's hard for me to say how bad my compensatory sweating really is...I'm usually fine unless I'm in a warm to hot environment while exerting myself.

I was so young when I had it done that it's hard for to really remember how bad it was. I do remember my arms, pits, and hands dripped sweat...like bad. Now my feet don't sweat unless it's warm..but yes when it's hot I sweat bad. My hands and face never sweat....in a sauna my hands might get slightly clammy.
 
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