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Benefits and risks

Benefits and risks

The evidence that NICE looked at showed that the procedure benefited many people. So although there was evidence of risks, NICE decided that the procedure was safe enough and worked well enough to be used on the NHS. The 14 studies that NICE looked at involved a total of 14,171 patients who had excessive sweating, blushing or both.

Generally, they showed the following benefits:

  • significantly less sweating from the palms than after treatment with botulinum toxin (Botox)

  • a 'satisfactory and lasting effect' around 15 years later

  • dry underarms and palms around 17 years later

  • significantly better patient satisfaction than with botulinum toxin

  • better quality of life.

Between 1% and 17% of patients' symptoms came back within 5 years.

The studies showed that the risks of the procedure included:

  • bleeding

  • severe sweating elsewhere on the body – this happened in over three-quarters of patients in 3 studies; a third of patients in 2 studies described it as 'severe' or 'incapacitating' and up to 20% of patients were dissatisfied or regretted having the procedure 15 or more years later

  • air, or blood or other bodily fluids leaking into the chest cavity, which had to be drained

  • a type of nerve damage called Horner's syndrome – this happened in a very small number of patients

Two patients' hearts stopped during the procedure – both recovered after they were resuscitated.

In one study 9 patients died after having the procedure – although the study didn't report what they were being treated for or the total number of patients being treated. Five died because of internal bleeding, 3 because of problems with the anaesthetic, and 1 had a stroke.

Some other problems reported in the studies were: air or gas in the tissues, fluid build up around the lungs, the airways narrowing, collapsed lung, wound infection, severe postoperative pain, nerve damage, paralysis, blood flow to the arm being blocked, a runny nose, persistent slow heart rate, heatstroke, and sweating brought on by eating.

NICE was also told about some other possible risks: fluid build up in the brain or lung, and pulmonary embolism (a blockage in the pulmonary artery, which is the blood vessel that carries blood from the heart to the lungs).

If you want to know more about the studies see the guidance. Ask your health professional to explain anything you don't understand.

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