Retroperitoneoscopic lumbar sympathectomy for the treatment of plantar hyperhidrosis: technique and preliminary findings.

Background: Patients with plantar hyperhidrosis suffer physically and mentally from a disease that often cannot be treated sufficiently using conservative measures. This article reports the authors' experience with endoscopic lumbar sympathectomies for patients with plantar hyperhidrosis.

Methods: Bilateral lumbar sympathectomy was performed for eight patients (3 women and 5 men). A retroperitoneoscopic surgical technique was used, during which the lower lumbar sympathetic trunk was resected after radiologic localization of the lumbar spine, with care taken to protect the cranial lumbar ganglia.

Results: All 16 sympathectomies were conducted retroperitoneoscopically, with no intra- or postoperative complications. In all cases, pedal sweat secretion was completely suspended postoperatively. After a 3- to 8-month follow-up period, the anhidrosis persisted in all cases (100%). None of the patients experienced sexual dysfunction. Five patients (62%) reportedly experienced minor compensatory sweating of the torso, and four patients (50%) had postsympathectomy neuralgia. Seven of eight patients were very happy with the postoperative results and would agree to a repeat of the intervention any time.

Conclusions: Retroperitoneoscopic resection of the lower lumbar sympathetic trunk is a safe and effective procedure for obtaining suspension of excessive sweat secretion in patients with plantar hyperhidrosis that cannot be treated with conservative methods.