Compensatory sweating: Once the palms (and soles) are dry, the body will
need to sweat from other areas to lose the excess heat and maintain the normal body
temperature. Most patients experience compensatory sweating from other parts of the body
like the trunk, face, lower limbs etc. This is usually mild and less disturbing than the
primary problem. This can sometimes manifest as severe sweating from some part of the
body (e.g. back, hips etc) that may make the patient regret the procedure. It is
difficult to predict this outcome preoperatively and all patients must be aware of this
before embarking on ETS. Restricting the number of levels cut and sparing the first 2
levels has found to be more acceptable.
Residual Symptoms: ETS will give excellent results in over 90% cases. In
the remaining, symptoms may partially or fully persist for unexplained reasons. These
include anatomical variations, aberrant nerve pathways etc.
Recurrence: occurs in 1-2% patients. This may be mild, usually in
situations like heavy physical activity, hot weather or other stressful situations. A
redo surgery is seldom required if symptoms are severe.
Heart rate changes: Reduction in heart rate may occur in a few cases,
but has no physiologic significance and no long term effect on the cardiovascular
Pneumothorax: Sometimes air remains inside the chest after surgery. This
is usually insignificant and gradually gets absorbed. Rarely, a small drainage tube may
be required to be placed in the chest to let the air out.
Gustatory sweating: Patients experience increased sweating while eating
or smelling certain foods. This is extremely rare.
Horner’s syndrome: This is also
known as ‘droopy eye syndrome’ and occurs due to damage to the C7 ganglion
if the sympathetic chain is attempted to be cut high at the level of the Stellate
ganglion (C7-T1). It is very rare, as it is common practice to spare T1.