Open Lumbar Sympathectomy
• Indications
TAO- Rest Pain, Non healing superficial ulcers
Hyperhiderosis
• Anesthesia: Spinal
• Position of the Patient: Lateral/ Kidney position
• Incision- From the tip of 12 rib to lateral border of rectus at the level of umbilicus.
Steps of Operation
• Step 1. Incision deepened by spltting the muscles
Anteriorly
External oblique
Internal oblique
Transversus abdominis
Posteriorly
Latissimus dorsi
Serratus posterior inferior
• Step 2. Peritoneum and the adherent ureter is pushed anteriorly.
• Step 3. Medial to Psoas major, sympathetic ganglia are felt over the vertebral body
• Step 4. L1 Ganglion is identified near the crus of the diaphragm
• Step 5. L 2, L 3 and L 4 Ganglia with intervening fibers are removed by protecting Aorta on left and IVC on right
• Step 6. Haemostasis achieved and the wound is closed in layers
Structures which can mimic a sympathetic chain
• Ilio inguinal and ilio hypogastric nerves
• Muscle sheath fibers
• Lymphatics with lymph nodes
Complications
Sterility due to Retrograde ejaculation, if L1 ganglia on both sides are removed.
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