Endoscopic Lumbar Sympathectomy for Women: Effect on Compensatory Sweat

Abstract

INTRODUCTIONPlantar hyperhidrosis is present in 50% of patients with hyperhidrosis. Thoracic sympathectomy is an important tool for the treatment of this condition, which is successful in about 60% of patients. For the remaining patients, lumbar sympathectomy is the procedure of choice. As new minimally invasive techniques have been developed, a significant demand for this type of access has led to its adaptation to the lumbar sympathectomy. The objective of this study was to evaluate the effectiveness of endoscopic retroperitoneal lumbar sympathectomy in controlling plantar hyperhidrosis and its effects on compensatory sweat.MATERIALS AND METHODSThirty female patients with persistent plantar hyperhidrosis after thoracic sympathectomy were enrolled. They were randomly assigned to laparoscopic retroperitoneal lumbar sympathectomy (Group A) or no surgical intervention (Group B - control) groups. Quality-of-life modifications were assessed by specific questionnaires before and after surgery. In the same manner, direct sweat measurements were also performed pre- and post-intervention by evaluating trans-epidermal water loss. Despite the lack of intervention, the control group was evaluated at similar timepoints.RESULTSIn Group A, no major complications occurred in the peri-operative period. During the immediate post-operative period, three patients (20%) experienced prolonged pain (more than ten days). Eight patients suffered from worsened compensatory sweating (53.3%). In Group A, after lumbar sympathectomy, the quality of life significantly improved (p<0.05, intra-group comparison) beyond that of the control group (p<0.05, inter-group comparison). Also, lumbar sympathectomy resulted in significantly lower values of foot sweat (pre- vs. post-operative periods, p<0.05; Group A vs. Group B, p<0.05). These patients also developed higher values of sweat measurements on specific points of their dorsal and abdominal regions after the procedure (p<0.05).CONCLUSIONSThe endoscopic retroperitoneal lumbar sympathectomy diminishes plantar sweat and improves the quality of life of women with plantar hyperhidrosis. However, about half of the patients develop increased compensatory hyperhidrosis in other areas of the body.

Totally videoscopic bilateral, simultaneous lumbar sympathectomy: original modification &#8211; preliminary report

“…In Figure 4 increased compensatory hyperhidrosis, described by Loureiro et al [11], and occurring in similar procedures on the thoracic sympathetic trunk [12], can be noted. However, the small study group and preliminary nature of this publication call for further evaluation in a larger group of patients.…”

“…Today, sympathectomy is tried for treatment of complex regional pain syndrome (CRPS) [9,10], primary hyperhidrosis (PHH) [11,12], Buerger's disease [13], Raynaud's syndrome [14,15], chronic leg ulcer [16], frostbite [17], erection problems [18], and painful legs and moving toes syndrome [19].…”

“…The ailment is estimated to make up 84.3% of all indications for surgical sympathectomy [23]. This is easily understandable, since 1% of the population are affected by the illness [11]. Primary hyperhidrosis is a hereditary disease of unclear aetiology and pathomechanism [24].…”

Diagnosis and Treatment of Primary Hyperhidrosis

“…Impact of lumbar sympathectomy performed as the second stage of treatment of compensatory hyperhidrosis is controversial (76). According to studies conducted by Loueiro in half of patients this procedure leads to escalation of the disease, while in other half to its decrease (76).…”

“…According to studies conducted by Loueiro in half of patients this procedure leads to escalation of the disease, while in other half to its decrease (76). Another interesting technical aspect is the extent of sympathectomy.…”