Several surgeons have been offering an experimental nerve reconstruction 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, and for all intents and purposes it is still an experimental surgery. I can not imagine how desperate some ETS patients have become to pay this much money and undergo the reversal surgery that is much more intensive and dangerous than the original ETS -- and then often get nothing from it, or maybe just psychological satisfaction that leads them to imagine some improvements. 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 solutions before even thinking of getting ETS surgery in the first place. 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."
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
Columbian's amazing documentation of his pre-ETS, post-ETS and post-reversal quality of life
Check out the Discussion Forums for hyperhidrosis treatments other than ETS surgery frequently to learn about what nonsurgical treatment (or combination of treatments) other hyperhidrosis sufferers are benefitting from. The aim of this website is to make sure people try all alternative treatments prior to getting ETS (and if they finally do end up getting ETS, I hope they choose a highly reputable and ethical surgeon based on advice given on this website that comes from personal experiences and years of 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 innacurate information from some unscrupulous surgeons, in the process ruining their quality of life. On the other hand, reading websites such as this and learning about numerous patient experiences in the forums makes the Internet an incredible avenue to learn and share experiences. The main point here is to take your time and conduct ample research before deciding to get ETS surgery.
Failure to exercise such caution could result in you the patient also becoming desperate and ending up blowing your life savings on this supposed reversal surgery in the future once the side effects of ETS begin to present themselves.
On another important note, the ETS reversal surgery involving clamp removal is also 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, not matter how the ganglion is destroyed, ETS represents permament damage to your sympathetic nevous system.
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 clamping ETS say that, theoretically, clamp removal very soon after surgery can lead to reversal to pre-surgical conditions in the patiet's body. However, there is no certainty about this as the nerves have been crushed (instead of cauterized, but basically still killed), 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!! Catch-22, Chicken and Egg etc...all benefitting the surgeons' advertising regarding clamping safety and short-term reversibility rather than the patient of course. The conclusion is that clamping, cutting, microcutting, electrocautery, electrocoagulation, resection, ablation etc... are all basically just ways for surgeons to differentiate themselves rather than safer or reversible techniques. Anyone who has taken a course in marketing will understand the importance of differentiation in capturing market share.
