Retroperitoneoscopic lumbar sympathectomy for plantar hyperhidrosis

The objective of this study was to assess the reduction in quality of life (QoL) caused by the persistence of primary plantar hyperhidrosis (PPH) symptoms and the level of satisfaction in PPH patients after retroperitoneoscopic lumbar sympathectomy (RLS). The efficacy, safety, and procedure of bilat...

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Bibliographic Details
Published in:Journal of vascular surgery 2017-12, Vol.66 (6), p.1806-1813
Main Authors: Lima, Sonia O., de Santana, Vanessa R., Valido, Daisy P., de Andrade, Renata L.B., Fontes, Leticia M., Leite, Victor Hugo O., Neto, José M., Santos, Jéssica M., Varjão, Lucas L., Reis, Francisco P.
Format: Article
Language:English
Subjects:
Cost of Illness
Endoscopy - adverse effects
Female
Foot
Ganglia, Sympathetic - physiopathology
Ganglia, Sympathetic - surgery
Humans
Hyperhidrosis - diagnosis
Hyperhidrosis - physiopathology
Hyperhidrosis - surgery
Longitudinal Studies
Lumbosacral Region
Male
Patient Satisfaction
Postoperative Complications - etiology
Private Practice
Quality of Life
Recurrence
Retrospective Studies
Severity of Illness Index
Surveys and Questionnaires
Sweat Glands - innervation
Sweating
Sympathectomy - adverse effects
Sympathectomy - methods
Time Factors
Treatment Outcome
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Summary:The objective of this study was to assess the reduction in quality of life (QoL) caused by the persistence of primary plantar hyperhidrosis (PPH) symptoms and the level of satisfaction in PPH patients after retroperitoneoscopic lumbar sympathectomy (RLS). The efficacy, safety, and procedure of bilateral RLS in both sexes are also described in this study. This is a longitudinal study of consecutive patients who sought specific treatment from a private practitioner for severe PPH as classified on the Hyperhidrosis Disease Severity Scale (HDSS) from October 2005 to October 2014. The patients were asked to report the symptoms of PPH experienced in the immediate preoperative period and to complete a standardized QoL questionnaire developed by de Campos at least 12 months after RLS. Disease outcomes, recurrence of symptoms, and any adverse effects of surgery were evaluated after 30 days and at least 12 months after RLS. Lumbar sympathectomy was performed 116 times in 58 patients; 30 days after surgery, PPH was resolved in all patients. Three patients (5.2%) reported transient thigh neuralgia, and 19 (32.7%) reported transient paresthesia in the lower limbs. There were no reports of retrograde ejaculation. At a minimum of 12 months after RLS, 49 of the 58 patients had fully and correctly answered the follow-up questionnaire and noted a mild (HDSS 2) to moderate (HDSS 3) increase in pre-existing compensatory sweating. One patient had a PPH relapse within 6 months. Improvement in QoL due to the resolution of PPH was reported in 98% of the 49 patients. None of the operations necessitated a change in the laparotomy approach, and none of the patients died. RLS is safe and effective for the treatment of severe PPH in both sexes. There were no reports of retrograde ejaculation after resection of L3 and L4 ganglia. There was a mild to moderate increase in compensatory sweating in about half of the patients, but without any regret or dissatisfaction for having undergone the surgery because of a significant improvement in QoL.
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2017.05.126