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A sympathectomy is a surgical procedure in which a portion of the sympathetic nerve is cauterized. This nerve runs parallel to the spine, inside the chest. Sympathectomy surgery is a treatment for certain blood vessel disorders, as well as a condition called hyperhidrosis, which causes excessive sweating.
The sympathetic nerve is an integral part of the sympathetic nervous system, which controls the “fight or flight” response to danger. When activated, the sympathetic nervous system speeds up the heart rate, increases the rate of respiration, causes blood vessels to constrict, and diverts blood away from the digestive tract and skin, and towards muscles. Sweating also increases as a side effect of adrenaline production. Collectively, these changes are known as the stress response, and enable the body to fight danger or escape from it.
Surgical procedures in which the sympathetic nerve is cut can relieve symptoms of a variety of disorders. One disorder often treated with a sympathectomy is called Raynaud’s phenomenon. This condition causes blood vessels in the ears, nose, toes, or fingers to constrict more than normal when exposed to low temperatures. Blood flow reduced and may even be cut off entirely. Chronic exposure to low temperatures may cause atrophy of the skin, ulcers, and even gangrene.
Sympathectomy is also used to treat hyperhidrosis. People with this condition sweat excessively, sometimes constantly, with no apparent cause. This condition develops because the sympathetic nervous system cannot effectively regulate body temperature in locations such as the hands, feet, back, and armpits.
Cutting the sympathetic nerve is an effective treatment for both of these conditions since they are caused by a dysfunction in the way the nerve works. In each case, the sympathetic nervous system is unable to properly regulate body temperature. By cutting the sympathetic nerve, the dysfunctional nerve signals which cause these conditions are prevented.
The sympathectomy procedure is fairly simple and is minimally invasive. It can provide a permanent cure for hyperhidrosis, and for Raynaud’s phenomenon, assuming the latter disease does not have another underlying cause. This surgery is usually carried out as an endoscopic procedure, which reduces post-operative pain and recovery time.
During the procedure, a small incision is made in a location close to the portion of the sympathetic nerve which is to be cut. This varies depending on the condition which is being treated; in the case of hyperhidrosis, for example, the cut is typically made just under the armpit. An endoscope is inserted through the incision, which is typically around one inch (2.5 cm) long. The endoscope is a fiberoptic tube which generates light and is fitted with a mini-camera which projects images onto a monitor the surgeon can view. The sympathetic nerve is then cut at the appropriate location, and may also be cauterized.
Most people have a hospital stay of only one day after undergoing a sympathectomy procedure. Some may even be able to return home the same day. Recovery is typically fast, and most patients can return to work after a week of rest.
This type of surgery is generally successful, but there is a small risk of temporary or permanent side effects relating to sympathetic nervous system function. Some people experience low blood pressure when standing, which can cause fainting. A small number of people who have this surgery for hyperhidrosis may actually experience an increase in sweating in some locations.