Several surgeons have been offering an experimental nerve reconstruction ETS reversal surgery at the cost of $20,000 or more the last I checked. This "reconstruction" surgery does not rebuild the destroyed T-2 ganglion. Rather, it is an attempt to somehow transmit signals from the lower ganglions to the palms, face and so on by bypassing the destroyed T-2 ganglion. Timo Telaranta of Finland seems to be the most experienced at this in terms of number of patients treated thus far using sural nerve graft transplant from the ankle to the sympathetic chain. Rafael Reisfeld in California is the second most experienced at this, but uses a different technique from Telaranta so is in effect the most experienced at his technique. Chien-Chi Lin of Taiwan also seems to have his own nerve reconstruction technique for reversal and could be more experienced than Reisfeld as far as numbers go, though its hard to tell.
To me, it seems that this reversal hardly ever works well enough to be worth it (excluding placebo successes in the short-term), and for all intents and purposes it is still an experimental surgery. Some ETS patients have become desperate due to their side effects, and are willing to pay this much money and undergo the reversal surgery that is much more intensive and dangerous than the original sympathectomy. These patients then often get no benefit from the reversal surgery, or sometimes get temporary psychological satisfaction that leads them to imagine some improvements in their condition. The fact that patients are undergoing this crazy reconstruction surgery is the best warning of all about why it is essential to try all possible nonsurgical hyperhidrosis treatments before even thinking of getting ETS surgery in the first place.
Some very useful links to find out more about ETS reversal surgeries:
Testimonials from reversal patients
Telaranta's summary of his reversal surgery results (he now uses a newer method)
Reisfeld's image of reversal surgery on his website
Lin's reversal surgery description and photos on his website at bottom
Check out the Hyperhidrosis Forum for hyperhidrosis treatments other than endoscopic thoracic sympathectomy frequently to learn about what nonsurgical treatment (or combination of treatments) other hyperhidrosis sufferers are benefiting from. The aim of this website is to make sure people try all alternative treatments prior to getting sympathectomy, and to provide extensive guidance on how to choose a reputable and ethical surgeon if a person attempts surgery (information that I have compiled as a result of years of personal experiences and research). The Internet represents a double edged sword for people suffering from medical conditions such as hyperhidrosis: on the one hand, gullible patients can be taken in by lies and inaccurate information from some unscrupulous surgeons, in the process ruining their quality of life. On the other hand, reading websites such as this and reading about numerous patient experiences in the forums makes the Internet an incredible avenue for learning and sharing experiences. Take your time and conduct ample research before deciding to get ETS surgery and then potentially having to get this expensive potentially useless reversal operation.
There is some hope that reversal surgery techniques will improve in the future. For example, a Japanese team has been doing some interesting work recently:
Repair of intra-thoracic autonomic nerves using chitosan tubes
On another important note, the ETS reversal surgery involving clamp removal is also somewhat of a myth (a fact supported by David Nielsen of Texas on his website with the words "reversibility questionable". Nielsen also discusses a host of other problems with clamping as opposed to his microcutting cutting). Many experienced surgeons worldwide continue to prefer electrocautery/electrocoagulation/cutting/resection over clamping to this day. In the end, no matter how the ganglion is destroyed, ETS represents permanent damage to your sympathetic nervous system.
According to the cigna website:
"There is no evidence in the peer-reviewed scientific literature to support that reversal or repeated sympathectomy is safe and effective in reversing compensatory sweating and other complications of ETS."
Alan Cameron also doesn't do clamping, saying in an e-mail to me that: "there is very little evidence of objective reversibility (but I agree some patients may feel better knowing the clamps are off which may help them). I use a single-puncture narrow instrument so I find cutting easier, but do clamp on request using two ports each side. But I emphasize that I do not believe it can be reversed (which was true for the two cases where I removed the clamps incidentally). I also think that cutting is a more effective way of doing ETS".
The surgeons who perform ETS via clamping say that, theoretically, clamp removal very soon after surgery can lead to a reversion to pre-surgical conditions in the patient's body. However, there is no certainty about this as the nerves have been crushed (which although cosmetically better than being burned via cautery, still leads to permanent destruction), and side effects typically change over the course of the first year after surgery in tandem with the weather/temperature outside and other unknown factors. You will never know your side effects until at least a year post surgery. But than its a moot point to remove the clamps since that can only be done with some possible benefit very soon after surgery! The conclusion is that clamping, cutting, microcutting, electrocautery, electrocoagulation, resection, ablation etc... are all basically just ways for surgeons to differentiate themselves to capture market share rather than being safer or reversible techniques.
With so many medical and technological advances having occurred on earth since the mid-1990s, my intuitition tells me that this trend will only accelerate in the next decade. A nonsurgical cure for hyperhidrosis is bound to occur between 2010-2020 in my opinion, and till then, I would recommend trying iontophoresis, botox and robinul and alternating between these solutions if necessary. As I am typing this paragraph while updating parts of this page in April 2010, google medical news tells me that a full face transplant has just occurred, a new artificial heart is the best yet, a company called Histogen has managed to grow new hair on balding people and more crazy things involving stem cells that I do not comprehend.
