The Risks and the Side effects of ETS:

Below is a list of possible symptoms which you may or may not encounter. Each person reacts differently, so please do not believe that you will develop all the symptoms below.

The side effects you may get depends a lot on which T you disconnected and with what method that was done, the more aggression the surgeon used on the nerve and the tissue the more
side effects. It is unclear how much the side effects differs between
the commonly used ETS methods listed above.

Alertness
Because the sympathetic nervous system controls some very specific functions that tie in directly to brain function, fiddling with it can severely deplete one's ability to concentrate and general sense of mental stability and alertness. A lot of ETS:ers describe it as a feeling of fuzziness

Death
There are 2 problems here: Firstly, the small number of people who have died on the operating table. Whilst there is a risk in any surgery, ultimately this is an unnecessary surgery. There is an argument as to whether ETS should be done unilaterally (one side at a time), thus avoiding the risk of collapsing both lungs in the same operation. The tragic death of an Irishman on the operation table last year received a coroner's verdict of death by medical misadventure, and High Court action has been commenced.
Secondly, death has followed ETS through consequent suicide due to side effects. Horribly, a young man in USA committed suicide in March 2003. Also around the world people have made multiple suicides and attempts, directly because of ETS side effects.

Fatigue
This loss of energy has been considerable enough to disable patients. Some degree of fatigue is not uncommon

Flushing
Many patients find that after ETS they develop a flushing problem. There seems a lot of confusion as to why this happens, so all we can do is repeat some of the ideas which attempt to explain this. A distinction is drawn here between blushing, and flushing. Sympathectomy surgeon Telaranta describes blushing as a sympathetic mechanism, whilst flushing is a parasympathetic mechanism. One might wonder then whether removing sympathetic tone allows the parasympathetic system to take over, thus causing flushing.

Another idea is that the sympathetic system is responsible for constricting the blood vessels, whilst the parasympathetic system allows for the opposite. Thus, removal of sympathetic tone allows too much parasympathetic stimuli, engendering vasodilatation, which manifests as redness on the face. This ties in with the reason for using ETS to treat Raynauds of the hands ~ to remove sympathetic tone, thus the blood vessels dilate, so that they get warmer. Telaranta is quoted as saying that dilation of blood vessels in the peripheries due to sympathectomy is a tool for treating Raynauds, but the same action does not happen in the face because the sympathetic system works differently there.

A much simpler idea is that, where before ETS, flushing due to heat, hormones and emotion could be avoided through the natural cooling mechanism of perspiration from the head, the inability to release this heat causes flushing.

ETS surgeon Reisfeld suggests the problem is due to denervation hypersensitivity. Here, the blood vessels become very sensitive to certain circulating hormones within the blood system

Gustatory Sweating
One of the few possible side effects which the Surgeons all acknowledge, though there is huge disparity in quoted incidence. One recent study (Video assistance reduces complication rate of thoracoscopic sympathicotomy for hyperhidrosis
(Johannes Zacherl, MDa, Martin Imhof, MDa, Erik R. Huber, MDa, Eugen G. Plas, MDa, Friedrich Herbst, MDa, Raimund Jakesz, MDa, Reinhold Függer, MDa) studied 558 patients and found 50.4% with Gustatory Sweating. Research Frey's Syndrome.

Heart problems
Bradycardia is a recognized potential side effect of sympathectomy. Two American patients of surgeons who also operate in Britain advised that PET scans showed damage to the sympathetic nerves innervating the heart. One was told that he was somewhere between normal and pure autonomic failure. While it is not uncommon to complain of reduced exercise capacity, very few have complained of significant heart problems.

Horner's syndrome
This can be brought about by both ETS and nerve graft "reversal". The low incidence of Horner's through sympathectomy possibly explains why it is always included as a possible side effect by promoters of sympathectomy. The occasional unfortunate ancillary advice that this is a condition that can be remedied by a simple operation is perhaps a little misleading.

Hyperhidrosis
The idea that post ETS hyperhidrosis is solely due to compensatory sweating is a nonsense. The total body perspiration experienced after ETS is greater than the total body perspiration before ETS. This extra amount has been described as "reflex sweating". No one fully understands it, but theories advanced attribute it to bad feedback from the build up of scar around nerves, or the break in communication between the brain and the lower body sweat glands. Even using the Surgeons' vocabulary, the nonsense statistics of reported compensatory sweating are now being replaced by more realistic figures, such as Gossot et al's 2001 publication about 940 patients, which advised an incidence of 100%. A 2003 publication by Gossot et al advised that compensatory hyperhidrosis did not improve with time.

Impotence
Long recognized to be a side effect of lumbar Sympathectomy (same nerve chain, though cut lower down the trunk), there has been a surprising reticence to acknowledge impotence due to thoracic Sympathectomy. The Radisson Group contains members with greatly reduced sexual strength which can not be attributed to psychological problems in the wake of ETS. Erec dys is a recognized symptom of autonomic dysfunction. (Indeed autonomic dysfunction also has symptoms of dizziness, bladder atone, dry eyes & mouth, and pupil abnormalities.) Sympathectomy is a massive trauma to the autonomic system. This seems to affect a relatively low percentage f people.

Oversensitivity to stress, sounds and lights, smells and
Many of us now react abnormally to simple stimuli of sounds, light and touch. Whilst ETS is sometimes performed to combat social phobia, many of us now have far reduced tolerance to stress.

Pain
Sympathectomy has long been touted as a "cure" for pain syndromes, such as the particularly nasty RSD (Reflex Sympathetic Dystrophy)/CRPS (Common Regional Pain Syndrome). Long term pain which can be easily and directly traceable to ETS does not seem terribly common. There are 2 important points to make here:
1) ETS is not a valid option for pain syndrome.
2) ETS can cause pain syndrome where there was none previously.

Puffy eyes
A common observation amongst ETS patients. This is interesting in that it is another symptom shared by patients with thyroid problems, which are ultimately disturbances to the endocrine system. Incidence is low, an example of how we are all affected in so many different ways.

Raynaud's Disease
This condition afflicts the peripheries, and is a touted reason for ETS. Many experienced warmer hands for some extended period after the operation, only for them to become sub normally cold afterwards.
ETS corrupts peripheral blood flow and causes a condition similar to Raynaud's.

Cold extremities
ETS causes contra lateral vasoconstriction, leading to cold extremities in the areas of sympathetic denervation. Many of us found that our hands were warmer than normal after ETS, before they gradually went the opposite way, and become prone to being frighteningly cold. The interesting question here, is that this does not apply purely to the areas of sympathetic denervation (hands, fingers, ears etc), but can also affect the feet, which maintain sympathetic innervation's after ETS.