Abstract
Background
Lumbar sympathectomy (LS) is still indicated for peripheral arterial occlusive diseases (PAOD) with critical ischemia beyond any vascular reconstruction. The retroperitoneoscopic approach was proven feasible and effective but its results were never evaluated in larger series.
Methods
Between January 2007 and January 2009, 50 patients were included in a prospective study (age range = 49–71 years; sex ratio: M/F = 9:1). Their comorbidities included arterial hypertension, n = 12 (24%); atrial fibrillation, n = 4 (8%); cerebral stroke sequels, n = 4 (8%); diabetes mellitus, n = 6 (12%); chronic coronary ischemic disease, n = 20 (40%); and obstructive bronchitis, n = 4 (8%). Fifty-one retroperitoneoscopic lumbar sympathectomies were performed (31 on the left side and 20 on the right side; 1 patient was operated on both sides).
Results
Intervention was successful in 50 cases (98.04%), with one conversion in the first three cases. Results were excellent in all patients, with warming of the extremity and regression of pain. The pathology report confirmed excision of the ganglia in all cases. Complications included 3 cases (6%) of accidental peritoneal tear and pneumoperitoneum which were resolved by insertion of a Veress needle in the hypochondrium; 2 (4%) retroperitoneal hematoma, and 6 (12%) superficial wound infections. Operative time was 65–105 min in the first ten cases and <40 min for the last 41. There was no neuralgia, sexual dysfunction, or postoperative mortality. Associated interventions included necrectomy in 10 cases. The limb preservation rate was 77.09% at 1 year and 58.69% at 2 years.
Conclusion
For a larger number of cases, retroperitoneal LS has been proven effective and safe in PAOD beyond reconstruction.
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References
Walker PM (1982) Is there still a place for lumbar sympathectomy? Can Med Assoc J 127:353–354
Baker DM, Lamerton AJ (1994) Operative lumbar sympathectomy for severe lower limb ischemia: still a valuable treatment option. Ann R Coll Surg Engl 76:50–53
Nesargikar PN, Ajit MK, Eyers PS, Nichols BJ, Chester JF (2009) Lumbar chemical sympathectomy in peripheral vascular disease: does it still have a role? Int J Surg 7(2):145–149
Kathouda N, Wattanasirichaigoon S, Tang E, Yassini P, Ngaorungsri U (1997) Laparoscopic lumbar sympathectomy. Surg Endosc 11:257–260
Hourlay P, Vangertruyden G, Verduyckt F, Trimpeneers F, Hendrickx J (1995) Endoscopic extraperitoneal lumbar sympathectomy. Surg Endosc 9:530–533
Watarida S, Shiraishi S, Fujimura M, Hirano M, Nishi T, Imura M, Yamamoto I (2002) Laparoscopic lumbar sympathectomy for lower-limb disease. Surg Endosc 16:500–503
Kuroda M, Koizuka S, Saito S, Sato E, Takizawa D, Goto F (2005) Computed tomography fluoroscopy-guided lumbar sympathectomy for a patient with peripheral vascular disease and lumbar spine compression fracture. J Anesth 19:268–269
Bulpa P, de Wispelaere JF, Dive A, Haufroid V, Installe E (2002) Acute cardiogenic shock after lumbar sympathectomy by phenol injection. Intensive Care Med 28:92–93
Antao B, Rowlands TE, Singh NP, McCleary AJ (2003) Pelviureteric junction disruption as a complication of chemical lumbar sympathectomy. Cardiovasc Surg 11(1):42–44
Seow CS, Doughty JC, Byrne DS (2000) Chemical lumbar sympathectomy revisited: survey of the current practice of vascular surgeons in Scotland. Eur J Surg 166(5):380–382
Debing E, Simoens C, Van den Brande P (2000) Retroperitoneoscopic lumbar sympathectomy with balloon dissection: clinical experience. J Laparoendosc Adv Surg Tech A 10(2):101–104
Disclosures
Drs. Nemeş, Şurlin, Chiuţu, E. Georgescu, M. Georgescu, and I. Georgescu have no conflicts of interests and financial ties to disclose.
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Nemeş, R., Şurlin, V., Chiuţu, L. et al. Retroperitoneoscopic lumbar sympathectomy: prospective study upon a series of 50 consecutive patients. Surg Endosc 25, 3066–3070 (2011). https://doi.org/10.1007/s00464-011-1671-8
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DOI: https://doi.org/10.1007/s00464-011-1671-8