• Does the excessive sweating (hyperhidrosis) improve spontaneously?
It is NOT possible to recover excessive sweating by itself. But, if the hyperhidrosis is because of some other diseases (secondary hyperhidrosis), it can recover after improving or treating the related disease.

• Will the secondary causes for excessive sweating be searched for before surgical procedure?
If needed, the related consultants (Internal Medicine, Cardiology, Oncology and Psychiatry, ..etc) will absolutely consult the patients for possible secondary hyperhidrosis causes.

• When does the impact of the surgical procedure begin?
The affect of the procedure starts immediately in less than 10 min after cutting or clipping the related sympathetic nerve ganglions. It can be seen that the hands and armpits become dry before leaving the operating room. And additionally, the hands become warm and oxygenated due to the dilatation of the vessels because of the disappearance of the sympathetic stress on the blood vessels of the hands. Most of the patients awake from anesthesia with having gotten rid of the excessive sweating.

• What are the success rates in the ETS technique?
Facial sweating and/or blushing (turning red) – 95-99% (95 to 99 patients out of 100)
Palmar (hand) sweating – 90-95% (90 to 95 patients out of 100)
Armpit sweating – 90% (90 patients out of 100)
Sole (foot) sweating – 50% (50 patients out of 100)

• Is the ETS a new technique in this field? Has it been proven successfull scientifically? (1,2)
Despite the open technique being performed for many years, the ETS method has started being performed since 1994-1995 as reported in many scientific papers in this field. Nowadays, it is being performed very commonly with high success rates.

• Can everyone get the ETS done?

1. First of all, the possible secondary sweating causes should be excluded with performing required organ system examinations, tests and consultations.
2. It can be performed in patients who have tried the methods other than surgery previously and have dissatisfied with the results (after proven being suitable for the surgery).

• In which conditions does not the ETS suggest for?

1. Patients who had previous chest surgical procedure (BUT, patients whose sweating has  very annoying impact on their daily lives can have the open sympathectomy done after proven being suitable for the surgery)
2. During the procedure, who has adhesion and scarring of the pleural membranes preventing the surgeon to see the surgical field clearly (previous thoracotomy, thoracoscopic procedures, inflammatory lung or heart diseases preventing single-lung ventilation and dense pleural thickening)
3. Patients who can not tolerate the surgical procedure (advanced lung and/or heart diseases)

• Complication Rates?

1. Compensatory sweating – 40-80%
2. Gustatory sweating (related to foods as pepper, spice, onion, garlic, .. etc) – 5-30%
3. Horner's syndrome (drop in the eyelids; mostly transient, improves in 1-3 months) – 1%
4. Pain – 2%
5. Bradycardia (decrease 10% in the heart rate; the heart rate should be over 50-60/min before surgery proven by ECG) - in almost every patient
6. Upon recurring of the hyperhidrosis, the ETS can reliably be performed again (redo surgery)

• Reversal Rate?

1. Reversal is IMPOSSIBLE in the patients who had the sympathetic ganglions cut or burned (ablated) during the procedure. It can be POSSIBLE in the ETS group who had clipping for the sympathectomy technique (10-20%).
2. Even the clips are removed, most of the time (80-90%) the efficacy of the surgical procedure will continue due to the crush injury and/or scarring of the sympathetic nerves during clipping.

• Can the ETS technique be done for the whole body sweating?

1. There is NO indication for the whole body sweating in the ETS method. There are proven and reported very high success rates for the local sweating conditions as facial, palmar, plantar (sole) and armpits.
2. There are some possible causes for the general sweating of the body (thyroid, diabetes, cancer, ..etc) and this should be searched detailly by related experts in the field.

• Is it possible for the sweating to recur at some time after the ETS procedure?

1. Transient sweating discharges might occur in 2-3 weeks after surgery which is NOT permanent.
2. The general success rates are being reported as 93-98% in many scientific papers. As it can easily be understood that the recurrence rates are 2-8% for 5 years after surgery. In another report, it has been declared that 50-60% of the patients who had the ETS are still satisfied with the results 12 years after the procedure (3,4).

References:
1. )Chen HJ, Shih DY, Fung ST. Transthoracic endoscopic sympathectomy in the treatment of palmar hyperhidrosis. Arch Surg. 1994;129(6):630-633;
2.) Harris J.P., May J., White G., Stephen M.,”Technique and Anatomy of Endoscopic Thoracic Sympathectomy”, Cardiovascular Surgery, Volume 3, Supplement 1, September 1995 , pp. 5-5(1)
3.) Ann Thorac Surg 2009;88:238-245;
4.) Interact CardioVasc Thorac Surg 2009;8:54-57; Ann Thorac Surg 2008;85:764-767; Ann Thorac Surg 2006;81:1048-10555