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What is a sympathectomy?

Deep inside your chest, a structure called the sympathetic nerve chain runs up and down along your spine. During a sympathectomy, a surgeon cuts or clamps this nerve chain. This keeps nerve signals from passing through it.

Why might I need a sympathectomy?

This procedure is used to treat a condition called hyperhidrosis or heavy sweating in the palms of the hands, the face, the underarms, and sometimes the feet. It's also used for facial blushing, some chronic pain conditions and Raynaud phenomenon — a condition that leads to profound sensitivity to cold temperatures and color changes of the skin. After a sympathectomy, the brain can't send signals to the involved areas to make them sweat, blush, or react to the cold as much. This permanent procedure is used as a last resort if other steps, such as antiperspirants or medications, haven't worked. 

What are the risks of sympathectomy?

As with any surgery that requires anesthesia, risks include breathing problems or reactions to the medications used to help you relax during the procedure. Other possible risks include:

  • Bleeding
  • Infection
  • Pain
  • More sweating in other parts of the body
  • Stroke or heart attack during the procedure
  • Collapsed lung
  • Injuries to nerves or blood vessels during the surgery
  • A problem called Horner’s syndrome, which is caused by nerve injury, and leads to eyelid drooping and trouble with the pupils of the eye.

You may have other risks, based on your specific medical condition. Be sure to talk with your healthcare provider about any concerns you have before your sympathectomy.

How do I get ready for a sympathectomy?

Ask your healthcare provider to tell you what you should do before your sympathectomy. Below is a list of common steps that you may be asked to do.

  • In addition to a complete medical history, your healthcare provider(s) may perform a physical exam to ensure you are in good health before you undergo the procedure. You may also undergo blood tests and other diagnostic tests. Your healthcare provider will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
  • You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something is not clear.
  • Tell your healthcare provider(s) if you are sensitive to or are allergic to any medications, latex, iodine, tape, contrast dyes, and anesthetic agents (local or general).
  • Tell your healthcare provider(s) of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
  • If you are pregnant or suspect that you are pregnant, you should notify your healthcare provider(s).
  • Tell your healthcare provider(s) if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
  • If you smoke, you should stop smoking as soon as possible prior to the procedure, in order to improve your chances for a successful recovery from surgery and to improve your overall health status.

What happens during a sympathectomy?

Before the surgery, you will be put completely to sleep. You won't feel or remember the procedure. The surgeon will make two or three small incisions (cuts) on one side of your chest below your underarm. Next, your lung will be temporarily collapsed and moved aside to allow the surgeon to reach the nerve chain along your spine.

The surgeon will then insert a small video camera and surgical tools to view and maneuver the nerve chain. Next, the surgeon will cut or clamp the nerve chain at the right level, depending on your exact symptoms.

When finished, the surgeon will re-expand the lung, remove the camera and instruments, and sew shut the incision. Then the surgeon will repeat the procedure on your other side. The entire surgery takes about an hour.

Talk with your healthcare provider about what you will experience during your sympathectomy.

What happens after a sympathectomy?

Your healthcare provider may give you other instructions about what you should do after your (procedure or test). Here is a typical list.

After the procedure, you will be taken to the recovery room for observation. Your recovery process will vary depending on the type of procedure performed and the type of anesthesia that is given. The incision site will be monitored closely. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room.

Most people can go home the day after the surgery. You should plan to have someone give you a ride home.

You may resume your normal diet unless your healthcare provider advises you differently.

You may feel pain for a week afterward. Your healthcare provider may suggest that you take over-the-counter or prescription pain medicine.

Ask your healthcare team how to keep the incisions clean. Avoid soaking in the tub or going swimming for two weeks.

You can probably do your normal activities after the surgery, but you may need to take it easy at first. No heavy lifting or vigorous exercises until your body has healed.

Most people can return to work within a week.

Be sure to take all of your medicines as prescribed and to attend any follow-up visits that your healthcare provider schedules.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • The risks and benefits of the test or procedure
  • When and where you are to have the test or procedure and who will do it
  • When and how will you get the results
  • How much will you have to pay for the test or procedure

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