Any operation can have the potential for a certain percentage of recurrence in patients. The ETS procedure could potentially result in recurrence. This is true regardless of the method used (clamping, cutting, or excisional).
Recurrences have been reported in medical studies. The statistic ranges between 1 to 4% depending on follow-ups made with the patients. The exact reason for recurrence is not understood. One possibility is re-growth of the nerve or the emergence of new pathways. Pregnancy also has the potential of increasing the recurrence rate.
Potential Factors For Recurrence
During a pregnancy, stem cells from the embryo can affect the re-growth of the sympathetic chain, which can cause a recurrence. There have been cases where symptoms came back during pregnancy and went away again after the child was born.
New pathways could be formed as well. This is due to the ability of sympathetic nerve cells within the spinal cord to assume the role of the sympathetic ganglia that were excluded during a sympathectomy. The sympathetic signals are being re-routed. This is currently a theory that has yet to be proven by research.
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.
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).
To summarize the above-mentioned descriptions it should be understood that the nervous system, both the autonomic and somatic (motoric or sensory), have billions of cells with interconnections. It is very difficult to trace those billions of connections. It brings us to the realization that the ultimate solution will be a genetic one. To completely guarantee a cure for hyperhidrosis, we would need to modify the gene responsible for the condition.
Another observation indicates that patients who are extremely anxious may be more likely to produce neurological transmitters (catecholamines) in their blood. This causes sweating which has nothing to do with the sympathetic chain.
This type of recurrence is almost impossible to predict because it’s dependent on the individual’s social response to anxiety.
The Different Types of Hyperhidrosis Recurrence
It is worth noting that the recurrence rate is a known fact among surgeons who are performing ETS procedures. It is not unique to any particular methods, which is why we have trouble understanding the exact reasons behind recurrence.
If the clamping method is performed at the T3-T4 level, this allows recurrent cases to go back to the T2 level by undergoing the procedure again. In cases where the operation was done at the T2 or T3 level, the second operation is performed between T4 to T5. It is very important for the surgeon to have a report from the first operation in order to make the appropriate decision.
The clamping method does not produce more scarring. As a matter of fact, performing ETS with the clamping method with less cauterization in the area of the sympathectomy causes far less scar formation than the cutting method.
Roughly 10% of patients who are going to have ETS or ELS procedures will experience a short recurrence of sweaty hands or sweaty feet. This will occur for about 3 to 4 days after the operation. It is only temporary and will stop.
Patients who had an ETS procedure and receive ELS may have a recurrence of sweating in their hands after ELS. It should be emphasized that this is rare and for a short time only. There is no exact explanation as to why it happens.
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 potential issues with your surgeon.
Can The Operation be Performed a Second Time?
Yes, a surgeon can go back and repeat the same operation. Each case must be reviewed carefully, as many factors must be considered. A second recurrence is extremely unlikely. Each case has to be discussed with the surgeon before a second attempt is made.
To learn more about what the ETS surgery can do for you, reach out by contacting our office.
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