Lumbar Sympathectomy for Plantar Hypeidrosis – 95 Cases

Marcelo Loureiro, Phd, Alexandre Bley, MD. Jacques Perissat Institut

Lumbar sympathectomy is the best treatment option for plantar hyperhidrosis, a disease that affects 1% of the population and causes severe social embarrassment. This surgery is being done for 8 years in our country by means of laparoscopic retroperitoneal approach . The author presents the experience of 95 patients operated, with a mean of 44 months (3-94).
They were 95 women and 1 man, all with excess feet sweat .Twenty six had also bromidrosis (foot odor). The technique used was the interruption of the chain by resection of the lumbar sympathetic ganglia L2 and L3. Ninety-two were operated simultaneously for both sides . The others had a second surgery performed between 3 and 6 months after the first.
There was no conversion to open surgery. The most frequent per-operative complication was the inadvertent opening of the peritoneum (18 cases or 19%), which naturally complicates any retroperitoneal laparoscopic surgery, but in these cases, not enough to convert them. Also we had a resection of genito-femoral nerve, confused with the lumbar sympathetic trunk, wich caused numbness in the top 1 / 3 of the right thigh.
Sixty one patients (63%) were found for follow up. Of these, the plantar hyperhidrosis was eliminated in 59 (97%) and bromoidrose in 21 (80%).
A potential side effect of sympathectomy is the development of compensatory sweating, or increased sweating in places it did not used to occur before surgery. This phenomenon began to occur in 18 patients (30%), and none of them considered that serious or disabling. Fifty-eight patients (95%) were satisfied or very satisfied with the surgery.
The endoscopic retroperitoneal lumbar sympathectomy is a very effective minimally invasive method in the treatment of plantar hyperhidrosis and its long term effects currently accredit it as the method of choice.