How to proceed
You can have more insight into your possibilities by filling up a follow-up questionnaire to inform us the situation before and after your original ETS. Please see the Contact page for more information.
ETS stands for Endoscopic Thoracic Sympathectomy, a surgical procedure in which a portion of the sympathetic nerve trunk in the thoracic region is destroyed. ETS can cause unwanted, compensatory excessive sweating (hyperhidrosis) in some patients. ETS-reversal may in some cases be performed to improve this side effect.
The aim of the surgery
The first aim in correctional surgery is to restore the normal neural pathways in the sympathetic chain. This is done by:
1. Excision of the scar tissue around the cut nerve ends. This often gives immediate relief in the compensatory hyperhidrosis by stopping the neuropathic feedback hypersensitivity. If pain has been included in the side effects, it is usually right away diminished after this neurolysis.
2. Adding fresh nerve stimuli to the midbrain structures. To accomplish this we transpose the living intercostal nerve to the stellate (T1) ganglion in cases where no decent end to end by-pass grafting is possible. This procedure adds to the possibility of thermoregulatory feedback between the lower sympathetic chain and the midbrain ganglia. Also the energy level may be restored, if damaged in the first surgery. This result is often immediate.
3. Microsurgical nerve reconstruction with a living intercostal nerve graft from inside of the chest wall is in addition used to unite the T1 and T2, possibly T3 and T4 ganglia, sometimes even further down. This way the normal continuity, interrupted by the ETS surgery, is restored and the face and hands usually regain some moisture and the reflex or compensatory sweating is further diminished. We no longer need to take any nerve from the ankle. The final recovery, however, can take more than a year and goes on for several years thereafter.
4. Both upper and lower Anastomosis are secured nowadays by suturing (6-8:0 stitches) and putting fibrin glue to the middle of the nerve graft.
5. Fat-derived stem cells are taken from patient’s abdominal fat tissue and put to the both anastomosis. Abdominal bandage are held during 2 weeks postoperatively. High-rich carbonhydrate diet is used four weeks before the operation.