This document outlines lumbar sympathectomy, a procedure to remove at least one sympathetic ganglion. It discusses the anatomy, indications, contraindications, types of procedures, operative steps, and complications. The key indications for lumbar sympathectomy include hyperhidrosis, causalgia, inoperative arterial occlusive disease causing rest pain or ulceration, and Raynaud's phenomenon. Potential complications include post-sympathectomy neuralgia, retrograde ejaculation, bleeding, and rarely paraplegia or ureteric necrosis. The document provides an overview of this irreversible surgical procedure.

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