Endoscopic Lumbar Sympathectomy Following Thoracic Sympathectomy in Patients with Palmoplantar Hyperhidrosis

Rieger, R.; Loureiro, Marcelo de Paula; Pedevilla, S.; Oliveira, Ramon Antunes de

doi:10.1007/s00268-010-0801-0

Cited by 27 publications

(24 citation statements)

References 29 publications

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“…The affected patients were only men and the pain was localized in the back- side, groin, thighs, or calves with no neurologic deficits 22 . Later, Rieger described a group of 18 patients (14%) who experienced transient neuralgiform pain that usually persisted only a few weeks and in individual cases for several months 25 . Mockus et al performed SE for CRPS and post-SE neuralgia occurred in close to 40%, lasted a little over a month on the average, but did not persist beyond ten weeks 26 .…”

Section: Discussionmentioning

confidence: 99%

Risk of sympathectomy after anterior and lateral lumbar interbody fusion procedures

Hrabálek¹,

Šternberský²,

Adamus³

2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aim. The aim of this study was to identify retrospectively, lumbar sympathectomy (SE) using thermography (TG) and to evaluate clinically, the severity of post-sympathectomy (post-SE) dysfunction after anterior and lateral lumbar interbody fusion procedures (ALIF, XLIF). Methods. Twenty eight patients with suspected SE were referred for TG to both legs. They completed our questionnaire on severity of difficulties after SE. We evaluated the ability of physical examinations to reveal the SE in contrast to TG and compared the symptoms (warmer leg and inhibited leg sweating) of SE with questionnaire responses as subjective measure and TG as objective measure. Results. SE was diagnosed in 0.5% after ALIF at L5/S1, in 15% after ALIF at Th12-L5 and in 4% after XLIF at T12-L5. SE severely reduced the quality of life in two cases. The ability to distinguish differences in leg temperature by palpation after SE was found in 32%. All physical examinations together were insufficient for reliably disclosing SE. Subjective symptoms of SE were often false positive and proven SE by TG was often a clinically false negative. Conclusion. This is the first study to examine post-SE dysfunction objectivelya using TG after ALIF and XLIF, and the first to evaluate clinically, the severity of the post-SE syndrome. Before surgery we cannot foresee potentially poor SE results. For this reason, injury to the sympathetic chain during surgery must be avoided. The advantage of TG for identifying SE is its non-invasiveness and reliability.

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Section: Discussionmentioning

confidence: 99%

Risk of sympathectomy after anterior and lateral lumbar interbody fusion procedures

Hrabálek¹,

Šternberský²,

Adamus³

2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…[56,95] For plantar hyperhidrosis, a variant procedure involving removal of the L3 ganglia can be performed, with improvement in sweating in up to 97% of patients. [96,97] However, there is a high risk of sexual dysfunction with lumbar sympathectomy for plantar hyperhidrosis. [98] Treatment of axillary hyperhidrosis by sympathectomy is difficult as the T-3 through T-6 ganglia must be destroyed to be efficacious.…”

Section: Sympathectomymentioning

confidence: 99%

Treatment Options for Hyperhidrosis

Walling¹,

Swick

2011

American Journal of Clinical Dermatology

122

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Hyperhidrosis is a disorder of excessive sweating beyond what is expected for thermoregulatory needs and environmental conditions. Primary hyperhidrosis has an estimated prevalence of nearly 3% and is associated with significant medical and psychosocial consequences. Most cases of hyperhidrosis involve areas of high eccrine density, particularly the axillae, palms, and soles, and less often the craniofacial area. Multiple therapies are available for the treatment of hyperhidrosis. Options include topical medications (most commonly aluminum chloride), iontophoresis, botulinum toxin injections, systemic medications (including glycopyrrolate and clonidine), and surgery (most commonly endoscopic thoracic sympathectomy [ETS]). The purpose of this article is to comprehensively review the literature on the subject, with a focus on new and emerging treatment options. Updated therapeutic algorithms are proposed for each commonly affected anatomic site, with practical procedural guidelines. For axillary and palmoplantar hyperhidrosis, topical treatment is recommended as first-line treatment. For axillary hyperhidrosis, botulinum toxin injections are recommended as second-line treatment, oral medications as third-line treatment, local surgery as fourth-line treatment, and ETS as fifth-line treatment. For palmar and plantar hyperhidrosis, we consider a trial of oral medications (glycopyrrolate 1-2 mg once or twice daily preferred to clonidine 0.1 mg twice daily) as second-line therapy due to the low cost, convenience, and emerging literature supporting their excellent safety and reasonable efficacy. Iontophoresis is considered third-line therapy for palmoplantar hyperhidrosis; efficacy is high although so are the initial levels of cost and inconvenience. Botulinum toxin injections are considered fourth-line treatment for palmoplantar hyperhidrosis; efficacy is high though the treatment remains expensive, must be repeated every 3-6 months, and is associated with pain and/or anesthesia-related complications. ETS is a fifth-line option for palmar hyperhidrosis but is not recommended for plantar hyperhidrosis due to anatomic risks. For craniofacial hyperhidrosis, oral medications (either glycopyrrolate or clonidine) are considered first-line therapy. Topical medications or botulinum toxin injections may be useful in some cases and ETS is an option for severe craniofacial hyperhidrosis.

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“…Excessive plantar sweating which is often associated with bromhidrosis, leads to massive physical and psychological stress for the patients and often results in depression and social isolation. With the help of lumbar sympathectomy, it is possible to eliminate the disease in more than 95% of all cases and achieve an increase in quality of life of the affected persons [10][11][12][13][14]. However, undesired concomitant effects may occur after lumbar sympathectomy in the form of so-called compensated sweating at the body trunk or head as well as temporary post-sympathectomy neuralgia.…”

Section: Discussionmentioning

confidence: 99%

“…However, one of the best indications for performing a lumbar sympathectomy is the severe primary plantar hyperhidrosis which cannot be managed with conservative measures [10][11][12][13][14]. Excessive plantar sweating which is often associated with bromhidrosis, leads to massive physical and psychological stress for the patients and often results in depression and social isolation.…”

Section: Discussionmentioning

confidence: 99%

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Video-assisted retroperitoneoscopic lumbar sympathectomy*

Rieger

2012

Eur Surg

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Background: Video-assisted retroperitoneoscopy is a relatively new surgical technique for performing lumbar sympathectomies and is used increasingly for the treatment of primary plantar hyperhidrosis. In this paper, we report on our clinical experience with this procedure.Methods: Between December 2004 and August 2011, 306 retroperitoneoscopic lumbar sympathectomies have been performed on 154 patients with severe refractory plantar hyperhidrosis. The perioperative course as well as the postoperative results were analysed in a retrospective analysis.Results: All 306 lumbar sympathectomies were performed in retroperitoneoscopic technique and in none of the cases a conversion to open surgery was necessary. Mortality was zero, and there were no serious intraoperative complications. In approx. 25% of the patients, the surgery was classified as technically difficult for a number of reasons. Postoperative complications occurred in 4 patients (2.6%) in the form of an abdominal wall haematoma, pneumonia, pulmonary embolism and a thrombosis of the right iliac vein. In all patients, the hyperhidrosis was eliminated immediately after surgery. 121 patients (79%) underwent follow-up controls 24 months after surgery on average. Three patients (2.5%) suffered a hyperhidrosis relapse. Adverse events occurred in form of compensatory sweating in 63 patients (52%) and in form of post-sympathectomy neuralgia in 47 patients (39%). Three men developed a temporary ejaculation disorder.Conclusions: Lumbar sympathectomy can be performed safely and effectively with retroperitoneoscopic surgical technique. Morbidity is low and the procedure is suited very well for the treatment of plantar hyperhidrosis. Since this surgery may be technically difficult because of the anatomic particularities of the retroperitoneum, high expertise with endoscopic surgical techniques is required.

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Endoscopic Lumbar Sympathectomy Following Thoracic Sympathectomy in Patients with Palmoplantar Hyperhidrosis

Cited by 27 publications

References 29 publications

Risk of sympathectomy after anterior and lateral lumbar interbody fusion procedures

Risk of sympathectomy after anterior and lateral lumbar interbody fusion procedures

Treatment Options for Hyperhidrosis

Video-assisted retroperitoneoscopic lumbar sympathectomy*

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