Lumbar Sympathectomy

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.