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Endoscopic Lumbar Sympathectomy – Side Effects

As with any surgery, one should expect some side effects which are directly related to the operation. Typically, patients are able to return to normal life within 2 to 3 days after the operation. Sports activity can be gradually resumed after 2 weeks.

These are some of the side effects you can expect during your recovery:

  • Pain – After ELS, pain is moderate in nature. Patients claim that they experience less pain after this type of surgery, than after ETS. The pain is tolerable with prescribed oral medications and will last a relatively short time (3-4 days). Less than 15% of patients develop temporary neuralgia which is pain from damage to very small superficial nerve fibers. Whenever skin is cut anywhere on the body, there are microscopic nerve fibers which are not seen by the naked eye. These nerve fibers can be cut and result in this temporary neuralgia. This pain can last from a few days to a few weeks, but the intensity will go down over time until it’s gone. The typical location of this pain is on the anterior surface of the thighs. Most of the time it occurs on one side.
  • Warm Feet – As a direct result of the sympathectomy, the blood vessels in the feet will become dilated. This dilation will bring more blood flow to the feet and increased warmth. This is a sign that the surgery was successful. The blood vessels will have their autonomous ability to constrict and dilate according to the needs of the body. This is normal and temporary.
  • Swelling – A successful sympathectomy will allow more blood into the foot region. This increased blood flow will cause some swelling of the feet that will subside as time goes by.
  • Scaring – The three scars on either side of the abdominal wall usually heal quickly with very minimal cosmetic issues. At times throughout the healing process, these scars will appear red, which is the body’s reaction to the dissolving sutures embedded within the skin.
  • Temporary Dizziness – A very small percentage of patients reported that, in the first day or two after the operation, they felt dizzy. This is a very temporary result of the increased blood flow to the lower extremities.
  • Possible Constipation – The instruction given to patients after endoscopic lumbar sympathectomy (ELS) is to resume their normal diet in a very slow fashion until the patient passes flatulence (gas). There are two reasons why the total resumption of bowel peristaltic activity can be delayed: 1) The ELS is done in an area behind the abdominal cavity (retro-peritoneal area), which is in close proximity to nerves in the bowels. Disruption here can cause delays in normal bowel movements. The instructions that are given to the patient (post surgery) are not to resume a full diet right away, but to wait until flatulence (gas) starts again. 2) It is likely that every patient uses a certain amount of pain killers. It is well known that all pain killers have some inhibiting effects on the peristaltic activity of the bowels. In order to prevent lengthy constipation symptoms, patients are told to use any laxative while they also take pain medication after the surgery.
  • Other Side Effects – Other extremely rare side effects include the possibility of more prolonged pain in the lower and upper legs (less than 1%). This could be due to prolonged dilatation of the blood vessels with increased blood flow to the legs and feet. This can last weeks. What was common in this very small subset group of patients, was the fact that those patients returned to regular physical activity very quickly. Extensive investigations to find the source of this pain did not show any abnormality. The best advice that we can give to patients is to slowly return to their normal physical activity. Eventually this type of pain will go away.
  • Patients Who Completed ETS First: For patients who had a previous ETS procedure before their ELS one, we have seen changes in sweating patterns that they did not experience after their ETS procedure. They might experience sweating on their scalp that was not there before. This is most likely a temporary and short lived phenomena. It is the result of different stimuli sent to the brain after the ELS procedure. One should always bear in mind that the sympathectomy procedure is a mechanical operation for a physiological problem. This results in a need for the body to get adjusted to the new procedure. It is usually a temporary issue that resolves itself over time.

ELS and compensatory sweating

Most of the patients who come for ELS are patients who previously had ETS. The level of compensatory sweating is usually determined by the previous ETS procedure. A very small number of patients undergo ELS as the first procedure.

In cases where ELS was done first, there is an amount of compensatory sweating but usually it is much less than after ETS.

Performing the ELS procedure after ETS does not block any more sympathetic chain segments than those which were already blocked by ETS. We know this may be a bit confusing so please contact us or your hyperhidrosis surgeon to ask questions.

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