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Lumbar Sympathectomy: (Surgical Solution for Excessive Foot Sweating)

Updated: May 2008

Lumbar sympathectomy is being done under general anesthesia. It involves 3 small cuts for the endoscopic approach into the retro-peritoneal area. Once the surgeon is there a space is developed and the sympathetic chain at the lumbar region is visualized. Once it is visualized it is either excised or clamped at the level L3-L4. This particular procedure is done on both sides. The operation takes about an hour to perform and in contrast to the endoscopic thoracic sympathectomy the patient should stay over at the hospital for one day.

(Update May, 2008) As more experience is gained even lumbar sympathectomy can be performed on an outpatient basis. In a typical case like this if the operation starts early in the morning, and the anatomical relations are displayed easily and nicely, the resultant pain and discomfort can be brought down to a minimum enabling a patient like this to leave the hospital in the late afternoon. Many more cases will have to be done in order to establish a definite pattern which would allow us to do the majority of the cases on an outpatient basis.

Lumbar Sympathectomy: Anatomical drawing showing where the incisions are made.

For the male patients the issue of retrograde ejaculation is a very important one. Even though in the clinical experience it was not proven to be a problem there is always a possibility and the security of sperm donation for future use if the retrograde ejaculation becomes a permanent problem.

Potential patients for Lumbar Sympathectomy should be aware of the fact that sometimes due to technical difficulties there might be a need to change the operation from endoscopically assisted Lumbar Sympathectomy to open Lumbar Sympathectomy. This will involve incisions on both sides measuring about two inches in size. The added discomfort or pain is very well tolerated by patients in situations where the operation had to be converted to open Lumbar Sympathectomy. The scarring is minimal and also is in an area that is very well accepted.

It is important to keep in mind this is a technical difficulty in doing the procedure and not a complication. Prior to the surgery the patient is given the very clear choice to allow conversion from endoscopically assisted to an open lumbar sympathectomy. The reason this is offered is to allow for more approaches to successfully complete the procedure.

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