The Systemic Adverse Effects of Endoscopic Thoracic Sympathectomy Are Underrecognized: A Questionnaire-Based Study

Background Endoscopic thoracic sympathectomy (ETS) is an effective treatment for focal hyperhidrosis and facial blushing, but its systemic adverse effects remain underrecognized. While compensatory sweating (CS) is widely acknowledged, other long-term sequelae such as fatigue, cognitive impairment, mood changes, and autonomic disturbances are poorly defined. Methods We conducted an anonymous, cross-sectional survey using the validated Chang Gung questionnaire, distributed via online hyperhidrosis communities. Adults ≥ 18 years with prior ETS (≥ 1 year postoperative) and healthy controls were included. Symptoms across multiple domains were rated on a 0–10 scale. Severity (median), prevalence (score > 0), and severe classification rates (score ≥ 8) were compared between groups. Results Of 487 respondents, 152 ETS patients and 177 controls were eligible. ETS patients exhibited markedly higher prevalence and severity of most systemic symptoms. CS affected > 80% of below-neck regions, with severe rates > 40%. Vascular and sensory changes included paresthesia, erythromelalgia, and cutaneous alterations. Neurocognitive disturbances (inattention, memory loss, brain fog) and mood symptoms (anxiety, depression) were significantly elevated. Most of the cardiorespiratory, gastrointestinal, and urogenital disturbances were also more sever and frequent. Conclusion ETS produces widespread systemic sequelae beyond CS, involving multiple organ systems and significantly impacting quality of life. These findings highlight the need for selective surgical strategies, thorough preoperative counseling, and exploration of reconstructive or alternative therapies.