title: Endoscopic lumbar sympathectomy following thoracic sympathectomy in patients with palmoplantar hyperhidrosis.
abstract: BACKGROUND
  Palmoplantar hyperhidrosis is a common disease that leads to significant psychosocial strain for the affected person. Although the treatment of palmar symptoms with endoscopic thoracic sympathectomy (ETS) is clinically established, there are few data on the efficacy of an endoscopic lumbar sympathectomy (ELS) for the elimination of plantar symptoms. Especially the occurrence of unwanted side effects associated with sequential ETS and ELS has not been examined sufficiently.
  
  
  METHODS
  The study includes 130 patients, 8 men and 122 women, with severe palmoplantar hyperhidrosis who were already previously treated with ETS. An average of 28 months after the ETS, bilateral ELS was performed on all patients due to persistent severe plantar hyperhidrosis. After ELS the perioperative morbidity, elimination rate of the plantar hyperhidrosis, the frequency of unwanted side effects, and satisfaction with the result were evaluated. Follow-up examinations were carried out on 96 patients (74%) with a mean follow-up of 37 months (3-90 months).
  
  
  RESULTS
  A total of 260 lumbar sympathectomies were successfully carried out endoscopically. Mortality was zero, intraoperative complications occurred in three (2.3%) patients and postoperative complications in six (4.6%). Plantar hyperhidrosis was eliminated in 93 patients (97%), 3 (3%) patients developed a one-sided recurrence. Seven patients (7%) developed minor compensatory sweating, and in 17 patients (18%) compensatory sweating that existed before the ELS was slightly increased. Transient postsympathectomy neuralgia was observed in 18 patients (19%), and none of the patients showed a sexual function disorder. Altogether, 77 patients (80%) were very satisfied with the postoperative result, and 16 (17%) were partially satisfied.
  
  
  CONCLUSIONS
  The sesequential performance of ELS after ETS appears to be a safe, effective therapy option for patients with severe palmoplantar hyperhidrosis. However, more experience with a larger number of patients and longer follow-up investigations are necessary to confirm the safety of four-limb sympathectomy.
authors.affiliation: Department of Surgery, Landeskrankenhaus Gmunden, Miller von Aichholzstrasse 49, 4810, Gmunden, Austria, Roman.Rieger@gespag.at.
authors.forename: Roman
authors.initials: R
authors.lastname: Rieger
authors.forename: Marcelo de Paula
authors.initials: Mde P
authors.lastname: Loureiro
authors.forename: Sonja
authors.initials: S
authors.lastname: Pedevilla
authors.forename: Ramon Antunes
authors.initials: RA
authors.lastname: de Oliveira
mesh_terms: 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 / Q000601:surgery; D008297:Male; D011183:Postoperative Complications; D012008:Recurrence; D013562:Sympathectomy / Q000379:methods*; D013906:Thoracoscopy; D016896:Treatment Outcome