Any operation being a technical procedure can have a certain amount of recurrences. The ETS procedure can also have recurrences and it does not make any difference which method was used (clamping, cutting, or excisional method). Recurrences have been reported in medical studies and it ranges between 1 to 4% depending how careful follow-ups are made with the patients. The exact reason for recurrence is not totally known yet. A possibility for this is re-growth of the nerve or the emergence of new pathways. Pregnancy also has the potential of increasing the recurrence rate slightly. The thought behind this is that during pregnancy stem cells from the embryo can affect the re-growth of the sympathetic chain and potentially cause recurrence.
In regards to new pathways for recurrence is the ability of sympathetic nerve cells within the spinal cord to assume the role of those sympathetic ganglia that were excluded during sympathectomy. To describe it in more simple terms the sympathetic signals are being re-routed. This is only a theory and a lot more research has to be done to draw any conclusions.
Another possible explanation for recurrence (ELS or ETS) is the known anatomical fact that sympathetic nerve cells coming from the spinal cord do not always connect to their anatomical ganglia in the sympathetic trunk. In simple terms this means that those original cells in the spinal cord can send connecting fibers up or down the spinal cord to connect to new sympathetic chain ganglia. (Reference - Clinical Autonomic Disorders: Evaluation and Management - Philip A. Low)
Another observation that was made over the years indicates that patients who are extremely anxious may be more likely to produce neurological transmitters (catecholamines) in their blood causing sweating which has nothing to do with the sympathetic chain. Obviously this is something that is embedded in ones personality and it very difficult to predict who will have a recurrence because of this observed phenomena.
In contrast to what has been written on other websites I would like to emphasize again that the recurrence rate is a known fact among surgeons who are performing ETS procedures. It is not unique to any particular methods and it presents an enigma as to why it happens and when. The clamping method if it is done at the T3-T4 level gives an opportunity in those recurrent cases to go back to the level T2 and re perform the operation. Also in contrast to what has been written on other websites, the clamping method does not produce more scars. As a matter of fact performing ETS with the clamping method with less cauterization in the area of the sympathectomy causes much less scar formation than in the cutting method.
About 10% of the patients who are going to have ETS or ELS will experience short recurrence of sweaty hands or sweaty feet which will occur at about 3 to 4 days after the operation. It is only temporary and will stop. It is very important to know whether the first 3 to 4 days were completely dry and if so the patients can be reassured that their recurrence is only temporary. Patients who had ETS previously and now have ELS might have recurrence of sweating in their hands after ELS. It should be Emphasized that this is rare and it should be for a short time only. There is no exact explanation as to why it happens. There are some theories but none can be proven at this point. More research is needed.
A true technical failure or unsuccessful operation will result in recurrence of the sweating either on the hands or the feet within a few hours to a day after the operation. As always please discuss these possible issues with your surgeon.Is a Redo operation an option?
Yes, a surgeon can go back and repeat the same operation. Each case must be reviewed carefully as many factors have to be considered. The re-recurrence rate is extremely low. Each case has to be discussed with the surgeon before a second attempt is made.
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