Retroperitoneoscopic lumbar sympathectomy for nonreconstructable arterial occlusive disease.
OBJECTIVE
The aim of this study was to present our experience with video-assisted lumbar sympathectomy for non-reconstructive arterial occlusive disease in a series of 23 consecutive patients whose predominant symptoms were unilateral rest pain, limited skin ulcerations or gangrene of the toes.


METHODS
All the procedures were performed with retroperitoneal approach, dorsal position of the patient and simple digital dissection of the retroperitoneal space.


RESULTS
The operations were successfully performed in all patients except for 2, who immediately underwent open conversion. A urinoma caused by ureteral lesion was the only severe complication in this series. The mean operative time of the procedure was 55 min and the hospital stay was 2 or 3 days. No parenteral analgesics were administered postoperatively. At 1 month from operation, 20 patients out of 23 had significant relief of rest pain and improvement of ischemic lesions. After a median follow-up of 36 months, 2 patients had died, 4 underwent some type of distal amputation, 1 had recurrent rest pain and the other 16 reported persistent improvement of pain or dystrophic changes.


CONCLUSIONS
Retro-peritoneoscopic technique appears the modern and less invasive version of the lumbar surgical sympathectomy.
Della Giovampaola
C
C
Department of Surgery, University School of Medicine, Università degli Studi di Pisa, Via Roma 67, 56100 Pisa, Italy.
Conte
M
M
Caldarelli
C
C
Zampieri
F
F
Battaglia
N
N
Spisni
R
R
Parente
B
B
Caldarelli
G
G
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007866:Leg / Q000098:blood supply; D008160:Lumbosacral Plexus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D013562:Sympathectomy / Q000379:methods*; D013919:Thromboangiitis Obliterans / Q000601:surgery*; D016896:Treatment Outcome; D020535:Video-Assisted Surgery