title: Endoscopic lumbar sympathectomy for women: effect on compensatory sweat.
abstract: BACKGROUND
  Plantar hyperhidrosis is present in 50% of patients with hyperhidrosis. Thoracic sympathectomy is an important tool for the treatment of this condition, which is successful in about 60% of patients. For the remaining patients, lumbar sympathectomy is the procedure of choice. As new minimally invasive techniques have been developed, a significant demand for this type of access has led to its adaptation to the lumbar sympathectomy. The objective of this study was to evaluate the effectiveness of endoscopic retroperitoneal lumbar sympathectomy in controlling plantar hyperhidrosis and its effects on compensatory sweat.
  
  
  METHODS
  Thirty female patients with persistent plantar hyperhidrosis after thoracic sympathectomy were enrolled. They were randomly assigned to laparoscopic retroperitoneal lumbar sympathectomy (Group A) or no surgical intervention (Group B - control) groups. Quality-of-life modifications were assessed by specific questionnaires before and after surgery. In the same manner, direct sweat measurements were also performed pre- and post-intervention by evaluating trans-epidermal water loss. Despite the lack of intervention, the control group was evaluated at similar timepoints.
  
  
  RESULTS
  In Group A, no major complications occurred in the peri-operative period. During the immediate post-operative period, three patients (20%) experienced prolonged pain (more than ten days). Eight patients suffered from worsened compensatory sweating (53.3%). In Group A, after lumbar sympathectomy, the quality of life significantly improved (p<0.05, intra-group comparison) beyond that of the control group (p<0.05, inter-group comparison). Also, lumbar sympathectomy resulted in significantly lower values of foot sweat (pre- vs. post-operative periods, p<0.05; Group A vs. Group B, p<0.05). These patients also developed higher values of sweat measurements on specific points of their dorsal and abdominal regions after the procedure (p<0.05).
  
  
  CONCLUSIONS
  The endoscopic retroperitoneal lumbar sympathectomy diminishes plantar sweat and improves the quality of life of women with plantar hyperhidrosis. However, about half of the patients develop increased compensatory hyperhidrosis in other areas of the body.
authors.affiliation: Programa de Pós-Graduação em Ciências - Cirurgia Torácica e Cardiovascular, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. mloureiro@unicenp.edu.br
authors.forename: Marcelo de Paula
authors.initials: Mde P
authors.lastname: Loureiro
authors.forename: José Ribas Milanez
authors.initials: JR
authors.lastname: de Campos
authors.forename: Paulo
authors.initials: P
authors.lastname: Kauffman
authors.forename: Fábio Biscegli
authors.initials: FB
authors.lastname: Jatene
authors.forename: Sheila
authors.initials: S
authors.lastname: Weigmann
authors.forename: Aline
authors.initials: A
authors.lastname: Fontana
mesh_terms: D000293:Adolescent; D000328:Adult; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005528:Foot / Q000503:physiopathology; D006225:Hand / Q000503:physiopathology; D006801:Humans; D006945:Hyperhidrosis / Q000503:physiopathology / Q000601:surgery*; D008161:Lumbosacral Region; D016658:Psoas Muscles / Q000601:surgery; D011788:Quality of Life; D012187:Retroperitoneal Space; D013546:Sweating / Q000502:physiology*; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult