lumber sympathectomy ppt

1. LUMBAR SYMPATHECTOMY
DR. ATUL KHARE

2. Outlines
• INTRODUCTION
• ANATOMY
• INDICATION
• CONTRAINDICATIONS
• TYPES OF LUMBAR SYMPATHECTOMY
• OPERATIVE STEPS
• COMPLICATIONS

3. Introduction
• It is a irreversible procedure during which at least one sympathetic
ganglion [post] is removed

4. Anatomy

5. Principle
• Increase blood flow
• Nutritive value for small ulcers
• Reduces ischemic rest pain
• Promoting collateral development

6. Indications
• Hyperhidrosis
• Causalgia [severe burning pain in a limb caused by injury to peripheral nerve – Reflux sympathetic dystrophy]
• Inoperative arterial occlusive disease with life threatening ischemia
causing rest pain, limited ulceration, superficial digital gangrene
• Symptomatic vasospastic disorders- Raynaud’s phenomenon and
frostbite victims
• Burgers disease , Atherosclerosis
• REST PAIN + ULCER+ SUPERFICIAL GANGRENE

7. Contraindications
• Intermittent claudication’s
• ABPI >0.3
• Diabetics [ autonomic neuropathy]

8. Types of surgery
• Retroperitoneal [extraperitoneal approach]
• Intraperitoneal approach
• Laparoscopic extraperitoneal LS
• Lumbar sympathetic block [ Sympatholysis ]

9. Extraperitoneal approach

10. STEPS

11. Intraperitoneal approach
• Indicated when abdomen is opened for some earlier condition
• Trendelenburg position with lower midline or paramedian incision
• Lateral surface of descending colon on left side and cecum and
ascending colon on right side mobilised.
• Indicated when abdomen is opened for some earlier condition

12. Lumber sympathetic block

14. Laparoscopic lumbar sympathectomy
• Laparoscopic lumbar sympathectomy

15. Complication
• Post-sympathectomy neuralgia [mc]
- 5-20 days post operation
- Annoying ache in anterolateral thigh, worse at night, unaffected by activity
- Responds to analgesics and spontaneously resolved 8-12 weeks
• Retrograde ejaculation
• Bleeding [lumber veins]
• Retroperitoneal hematoma/abscess
• Compensatory hyperhidrosis
• Paraplegia [extradural injection]
• ureteric necrosis
• Lymphatic ooze [left side]
• Paralytic ileus

16. • THANK YOU

17. • Structure mistaken= lymphatic chain, genitofemoral nerve, psoas
sheath, psoas minor, lateral arcuate ligament