A systematic review and meta‐analysis to evaluate the efficacy of lumbar sympathectomy for plantar hyperhidrosis

Abstract

Results There were no deaths, and the resolution of symptoms of primary plantar hyperhidrosis (PPH) occurred in 92% of patients after mechanical sympathectomy. A total of 177 patients (44%) were reported to have mild to severe compensatory sweating after a mean 6 months follow-up. The preservation of L2 did not interfere with the primary outcome, and it is possible to perform lumbar sympathectomy in men with L2 preservation, achieving satisfactory cure results of PPH, minimizing the risk of sexual dysfunction. There were no deaths, and the resolution of symptoms of PPH occurred in 10% of patients after chemical sympathicolysis after a mean 6 months follow-up. A total of 13 patients (12.5%) were reported to have mild to severe compensatory sweating using the same technique. ConclusionThe mechanical lumbar sympathectomy is effective and safe and improves quality of life, evaluated by the high symptom resolution of PPH and low rate of complications. The chemical sympathicolysis in the immediate postoperative period presented satisfactory results; however, it was shown to be significantly less effective than the mechanical approach in a follow-up of at least 6 months.

Effects of lower thoracic sympathicotomy on plantar hyperhidrosis

“…The leg and foot are innervated by the efferent sudomotor fibers coming from the ipsilateral segments from T10 to L4 (16,17). Recently, lumbar sympathectomy is accepted as an effective treatment for plantar hyperhidrosis (16)(17)(18)21). However, the chief complaint in patients with PH is usually palmar hyperhidrosis.…”

How to do a retroperitoneoscopic lumbar sympathectomy

“…Lumbar sympathectomy has been utilised for a number of indications; however, currently the most common indication is primary plantar hyperhidrosis for which sympathectomy has been shown an effective and potentially curative treatment. 1,2 The development of the retroperitoneoscopic lumbar sympathectomy (first described in the 1990s) has allowed a less invasive alternative to open sympathectomy with good efficacy and durability. 1,2 While most patients with plantar hyperhidrosis are treated with nonsurgical therapies, patients with refractory symptoms that significantly impair their quality of life should be referred to a surgeon experienced in treating the condition and in the retroperitoneoscopic technique.…”

“…1,2 The development of the retroperitoneoscopic lumbar sympathectomy (first described in the 1990s) has allowed a less invasive alternative to open sympathectomy with good efficacy and durability. 1,2 While most patients with plantar hyperhidrosis are treated with nonsurgical therapies, patients with refractory symptoms that significantly impair their quality of life should be referred to a surgeon experienced in treating the condition and in the retroperitoneoscopic technique. 3…”

“…Lumbar sympathectomy has been utilised for a number of indications; however, currently the most common indication is primary plantar hyperhidrosis for which sympathectomy has been shown an effective and potentially curative treatment 1,2 . The development of the retroperitoneoscopic lumbar sympathectomy (first described in the 1990s) has allowed a less invasive alternative to open sympathectomy with good efficacy and durability 1,2 …”