Sympathectomy

A sympathectomy is a rare, minimally invasive surgery that cuts certain nerves in your sympathetic nervous system. This system controls automatic functions that you don’t have to think about, like sweating. By cutting the nerve, this surgery blocks a signal that triggers an automatic function in a specific part of your body.

Surgeons usually do this procedure to stop the nerve signals that trigger excessive sweating (hyperhidrosis). For example, to treat this condition in your hands, arms or feet, a surgeon will cut a nerve in your chest.

What are common conditions treated by a sympathectomy?

Providers can use this procedure to manage the following conditions:

• Excessive sweating (hyperhidrosis)
• Severe facial flushing (blushing)
• Certain life-threatening abnormal heart rhythms (arrhythmias)

This type of surgery is uncommon. It’s typically only done when other treatments for these conditions haven’t worked.

How should I prepare for a sympathectomy?

You’ll meet with your surgeon before the day of your procedure. They may schedule tests, like blood tests and a chest X-ray, to check your overall health and plan for the operation.

Your provider will give you specific instructions to follow. This may include guidance on what you should or shouldn’t eat or drink the night before surgery. If you smoke, you should cut back or stop smoking.

They may also tell you to stop taking certain medications before the procedure (like a blood thinner) if that’s part of your daily routine. Don’t make changes to your medications unless your provider tells you to do so.

You should also arrange for someone to drive you to and from the hospital.

What happens during a sympathectomy?

The steps vary slightly based on what your surgeon is treating.

This surgery happens under general anesthesia. An anesthesiologist will put you to sleep so you won’t feel any pain.

The procedure is minimally invasive. Your surgeon may use robotics or thoracoscopic surgery.

To treat hyperhidrosis, a surgeon will:

1. Make a small incision or cut between two ribs under your armpit on one side
2. Put a tool with a camera through the cut (endoscope)
3. Reduce the amount of air in your lung so they can see the nerve better
4. Make a second incision between your ribs toward the middle of your side and, likely, another small incision between your ribs
5. Put tools in the incisions and use them to cut the nerve or clamp it with a clip
6. Remove all the tools from your chest
7. Leave a drainage tube and insert pain medication
8. Add more air back into your lung
9. Close the incision sites

If excessive sweating occurs on both sides of your body, your surgeon will work on one side at a time.

How long does a sympathectomy take?

Your surgeon will have the best time estimate. It varies based on what they need to do and your underlying conditions and surgical history. Generally, it can take one to two hours.

Benefits of this procedure

The benefits of a sympathectomy may include:

• Improved quality of life
• Permanent results
• Quick healing time

This procedure usually works well to reduce sweating in your hands and armpits.

You may need a second surgery if hyperhidrosis returns on one or both sides of your body. This may happen if the initial nerve cut was incomplete or if sweat signals reroute through nearby nerves.

Side effects of a sympathectomy

As with any type of surgical procedure, there are potential side effects. These may include:

• Bleeding
• Infection
• No symptom relief
• Pain
• Reaction to anesthesia

Side effects specific to a sympathectomy to manage hyperhidrosis may include:

• Slow heart rate
• Collapsed lung or other issues with reinflating your lung (rare)
• Drooping eyelid (rare)
• Severe sweating in other parts of your body, like your thighs, back, groin or belly
• Sweating on your head and neck after you eat
• Very dry skin

A sympathectomy usually can’t be reversed. But it may be possible in some situations. You might consider reversal (if possible) if you develop severe sweating in other parts of your body after the procedure.

What happens after a sympathectomy?

After the procedure, you’ll move to an area of the hospital for observation until the anesthesia wears off.

In most cases, you can go home the same day. You’ll need someone to drive you home. In some cases, you may need to stay overnight at the hospital. Your provider will let you know what you can expect.

You’ll likely experience some pain following surgery. You may also have some tingling or numbness. This should get better in the first few weeks. You should be able to manage it with medicines like NSAIDs or a prescription your provider gives you.

Follow your provider’s instructions after surgery. This may include how to care for the incision site, when to come back for a follow-up appointment and what activities are safe to do.

What is the recovery time of a sympathectomy?

Recovery time depends on the type of procedure you have. The incision site usually takes a few weeks to fully heal.

Take it easy for the first few days after surgery. Most people can return to normal activities within one to two weeks. Your provider will let you know when it’s safe to continue all physical activities.

You can shower, but avoid baths or swimming for at least two weeks. Don’t do strenuous exercises or lift heavy objects until your provider gives the OK.

When should I call my healthcare provider?

Contact your provider if you develop signs of infection, like:

• A fever
• Pus leaking from the incision site
• Severe pain that doesn’t improve with medication
• Swelling

You’ll have a follow-up visit a couple of weeks after surgery, then several more during the first year. After that, you’ll likely have yearly check-ins for up to five years.