The systemic adverse effects of endoscopic thoracic sympathectomy are underrecognized: a questionnaire-based study

Endoscopic thoracic sympathectomy (ETS) is an established treatment for focal hyperhidrosis and facial blushing; however, its systemic adverse effects remain underrecognized. Beyond compensatory sweating (CS), the potential multisystemic and neuropsychological sequelae of sympathetic disruption have not been comprehensively characterized. An anonymous, cross-sectional online survey was conducted using the internally validated Chang Gung Sympathetic Function Questionnaire (CG-SFQ). The CG-SFQ demonstrated excellent reliability (Cronbach’s α = 0.90–0.95) and construct validity (KMO = 0.85–0.95; Bartlett’s p < 0.001). Adults (≥ 18 years) who had undergone ETS ≥ 1 year previously and healthy controls were compared across four domains—thermoregulatory/sweating, vascular/cutaneous, psychological/central nervous system, and systemic (cardiorespiratory, gastrointestinal, urogenital, musculoskeletal). Symptoms were rated on a 0–10 numeric scale, and intergroup comparisons were performed for prevalence, severity, and proportion of severe cases (≥ 8). A total of 329 participants (152 ETS, 177 controls) were analyzed. ETS patients exhibited significantly higher prevalence and severity across all domains. More than 80% of patients experienced CS in below-neck regions following ETS, with severe intensity exceeding 40%. Vascular dysregulation, paresthesia, and cutaneous changes were frequent. Neurocognitive and mood disturbances—including fatigue, inattention, and anxiety—were markedly elevated, while cardiorespiratory, gastrointestinal, and urogenital complaints were also significantly more common. These findings indicate a widespread disturbance of sympathetic regulation across central and peripheral pathways. 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.