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Transthoracic endoscopic sympathectomy (TES)

Transthoracic endosopic sympathectomy or TES is the surgical option that may be offered as a treatment for hyperhidrosis. TES is most effective for excessive hand, facial  and underarm (axillary) sweating with reported results of between 75% and 97% reduction in symptoms.

The surgery is carried out by minimal access surgery (keyhole)  and can be performed through 1 -2
small incisions in each side of the chest.  The surgery works by interrupting the sympathetic nerves that carry the signals to the sweat glands.

TES may be used for axillary sweating but is not normally regarded as the primary treatment due to the availability of Botox®  injections.

Although this is not a recommended treatment for plantar hyperhidrosis (excessive sweating of the feet) some patients notice less sweating of the feet after TES, although it can also get worse.

TES is also an effective treatment for facial blushing.

Patients considering this surgical option must realise that this operation should be regarded as permanent and irreversible although symptoms may return after surgery.

Risks and complications of TES
Mild compensatory sweating is the most frequently reported complication after this type of surgery. Increased sweating in other areas of the body such as the trunk or groins is quoted as affecting up to 75% of patients following TES.   
This level of compensatory sweating is usually an acceptable complication to most patients.
In up to 10% of patients compensatory sweating (i.e. increased sweating elsewhere, usually on the trunk) can be very severe, enough to cause a major problem. This may lead to regrets over the decision to opt for surgery.
Sympathectomy for combined axillary and hand sweating is more extensive and has a greater risk of compensatory sweating due to the greater number of sympathetic nerves that need to be destroyed.
Less than 1% of patient develop Hornerís syndrome following TES.  This is where there is damage to the sympathetic nerve to the eye causing a slight droop to the eyelid and a small pupil. This is usually temporary but may be permanent. The droopy eyelid may be a cosmetic concern
Rarely patients may notice that they have an increase in sweating after eating certain foods.
A small number of patients (less than 1%) develop a collapsed lung after surgery; this may require the insertion of a chest drain.
∑In a small number of patients (about 5%) the surgery fails to control the sweating.
After the operation patients may experience some chest wall or shoulder discomfort. This is from the gas which is used during the operation and from the surgical wounds. Painkillers to help with this pain will be given.
As with any operation there is always the possibility of developing a wound infection. If required antibiotics would be prescribed.
A small number of patients have nerve pain around the wound area or the torso. This is called Intercostal neuralgia and usually subsides over a few weeks.
As with any operation there is always a chance of bleeding post operatively.  This may require a return to the operating theatre, and major chest surgery.
You may develop dry hands after this operation. This can be helped by the application of hand creams.
Although extremely rare there is a possibility of dying from major complications following this type of surgery.



Futher information
The information contained on this website is intended as a guide only, it is not intended to substitute for medical consultation, diagnosis or treatment.
Please see your doctor with any questions regarding personal health or medical conditions

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