The importance of classification in sympathetic surgery and a proposed mechanism for compensatory hyperhidrosis: experience with 464 cases

Excerpt

I recently read the article by Chao et al. [1]. As a surgeon who has performed endoscopic thoracic sympathectomy (ETS) in nearly 3000 patients, including more than 1500 using what the authors refer to as ESB or “clipping” and which I call “clamping,” I do have some comments for the authors. First, the authors indicate that they did not have any cases of recurrence. This is quite unusual. Although we know that obtaining results from a clinical study is a function of time and thoroughness of follow-up, almost every published study shows a certain percentage of recurrence, no matter what method was used [2‐8]. The rate may be low, and I myself have reported recurrence rates that have improved over time with differing approaches: 5.4% in cases before 1999 and 1.0%–1.4% in more recent series [5‐7]. The Chou et al. study was retrospective. The authors indicate that they performed a telephone questionnaire “before the study was performed” to determine recurrence, among other variables, but do not indicate the response rate. The data tables and percentages presented implied a 100% response, a nearly impossible response rate for a retrospective study conducted in the United States. Most surgeons should not expect a 0% recurrence rate. …