title: Retroperitoneoscopic lumbar sympathectomy: prospective study upon a series of 50 consecutive patients.
abstract: BACKGROUND
  Lumbar sympathectomy (LS) is still indicated for peripheral arterial occlusive diseases (PAOD) with critical ischemia beyond any vascular reconstruction. The retroperitoneoscopic approach was proven feasible and effective but its results were never evaluated in larger series.
  
  
  METHODS
  Between January 2007 and January 2009, 50 patients were included in a prospective study (age range = 49-71 years; sex ratio: M/F = 9:1). Their comorbidities included arterial hypertension, n = 12 (24%); atrial fibrillation, n = 4 (8%); cerebral stroke sequels, n = 4 (8%); diabetes mellitus, n = 6 (12%); chronic coronary ischemic disease, n = 20 (40%); and obstructive bronchitis, n = 4 (8%). Fifty-one retroperitoneoscopic lumbar sympathectomies were performed (31 on the left side and 20 on the right side; 1 patient was operated on both sides).
  
  
  RESULTS
  Intervention was successful in 50 cases (98.04%), with one conversion in the first three cases. Results were excellent in all patients, with warming of the extremity and regression of pain. The pathology report confirmed excision of the ganglia in all cases. Complications included 3 cases (6%) of accidental peritoneal tear and pneumoperitoneum which were resolved by insertion of a Veress needle in the hypochondrium; 2 (4%) retroperitoneal hematoma, and 6 (12%) superficial wound infections. Operative time was 65-105 min in the first ten cases and <40 min for the last 41. There was no neuralgia, sexual dysfunction, or postoperative mortality. Associated interventions included necrectomy in 10 cases. The limb preservation rate was 77.09% at 1 year and 58.69% at 2 years.
  
  
  CONCLUSIONS
  For a larger number of cases, retroperitoneal LS has been proven effective and safe in PAOD beyond reconstruction.
authors.affiliation: First Clinic of Surgery, University of Medicine and Pharmacy of Craiova, Petru Rares 2, 200349 Craiova, Dolj, Romania.
authors.forename: Raducu
authors.initials: R
authors.lastname: Nemeş
authors.forename: Valeriu
authors.initials: V
authors.lastname: Şurlin
authors.forename: Luminiţa
authors.initials: L
authors.lastname: Chiuţu
authors.forename: Eugen
authors.initials: E
authors.lastname: Georgescu
authors.forename: Milena
authors.initials: M
authors.lastname: Georgescu
authors.forename: Ion
authors.initials: I
authors.lastname: Georgescu
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D015171:Ganglionectomy / Q000379:methods*; D006801:Humans; D007511:Ischemia / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D007866:Leg / Q000098:blood supply; D008160:Lumbosacral Plexus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000601:surgery*; D011446:Prospective Studies; D012187:Retroperitoneal Space