Operation sympathectomy - what is it, patient reviews, types. Lumbar and Thoracic Sympathectomy Sympathectomy – Surgical Treatment for Excessive Sweating

There are times when hyperhidrosis cannot be managed with external means and medicines.

The only way to eliminate increased sweating sympathectomy remains - the operation of cutting the trunk of the sympathetic nerve.

The sympathetic nervous system is responsible for the active work of the sweat glands. Its peripheral part (sympathetic trunk) is located on the surface of the spine, along its entire length. Nerve fibers depart from the trunk, innervating various organs and glands, including sweat glands.

The method of sympathectomy is based on clamping or complete destruction of the branches of the sympathetic trunk, which are responsible for the innervation of the sweat glands of the axillary region, palms, and less often feet.

In this case, sweating in the problem area stops completely. Despite all its effectiveness, the operation has many disadvantages, due to which it is used only in severe cases of hyperhidrosis, which is not amenable to other treatment.

Having figured out what sympathectomy is, it is worth learning in more detail about who is assigned this species surgical intervention. She has few indications, and they are all associated with excessive activity of the sympathetic nervous system.

The operation is carried out in the following cases:

primary, not associated with other diseases;
Raynaud's disease - damage to the small vessels of the hands, manifested by spasm of the fingers, their swelling, cyanosis and the formation of trophic ulcers;
blushing syndrome - intense redness of the face that occurs with any manifestation of emotions;
Zudek's syndrome is a post-traumatic pain syndrome with severe disorders of the trophism of the extremities.

Before sympathectomy, a thorough examination of the patient is carried out in order to confirm the need for it and to identify any deviations in the state of health that may affect the course of the operation and the course of the postoperative period.

The operation to cut the branches of the sympathetic trunk has many risks:

According to patients with sympathectomy, after the operation, sweating in other places increases. This phenomenon is called compensatory hyperhidrosis. It happens due to the fact that when the sweat glands stop working in one area, in order to maintain the processes of normal thermoregulation, an increased output of fluid by the glands of other parts of the body is required. This effect develops in 5% of those operated.
The occurrence of relapses. In case of incomplete operation, recovery is possible nerve fibers sympathetic trunk, which leads to the absence of the desired effect.
Injury to the intrathoracic sympathetic ganglion. Accompanied by Horner's syndrome, manifested in a unilateral violation of innervation eye muscles: omission upper eyelid, unusually narrow pupil, retraction eyeball.
The ingress of air or blood between the layers of the pleura (pneumothorax / hemothorax) due to incorrect actions of the surgeon during sympathectomy.
Pain syndrome after surgery. Normally, it lasts no more than a few days.
Harlequin Syndrome. Unilateral reddening of the skin and sweating that occurs with incomplete destruction of nerve fibers.
Side effects general anesthesia: nausea, headaches, allergic reaction, pain syndrome, pulmonary infections.

According to the degree of destruction of the branches of the sympathetic trunk, the following types of sympathectomy operations are distinguished:

Reversible. A clamping clip is applied to the nerve fibers, which disrupts the conduction of the impulse to the sweat glands. This type of intervention is convenient because with the development of compensatory hyperhidrosis in other parts of the body, the clip can be removed and side effects eliminated. This is possible in the first three months after the operation, then the nerve is irreversibly damaged. Sometimes the clip does not always completely compress the nerve and the operation does not bring the desired effect.
Irreversible. The nerve is severed, leaving him no chance to recover. Sweating in the operated area disappears forever, there is no possibility for nerve regeneration during the development of compensatory hyperhidrosis.

The methods of the operation also differ:

Open sympathectomy. An incision is made along the back of the chest between the ribs, through which access to the desired nerve is achieved. It is crossed or clamped with a clip. This method is outdated and is practically not carried out - it is extremely traumatic, the period of postoperative rehabilitation is long, and a deep scar remains at the incision site.
percutaneous method. Through a small incision, under the control of radiography, an electrode is inserted, which burns out the nerve. A catheter is also inserted, through which a chemical cauterizing substance enters the nerve. The method is time-consuming, there is a high probability of injury to the pleura, neighboring nerves and blood vessels. Not widely used.
Endoscopic sympathectomy. Through punctures in the skin, special endoscopic instruments and a mini-camera are inserted, which allows the surgeon to control all his actions. The sympathetic nerve is cut or pinched at the desired location. With this type of surgical intervention, the risks of erroneous injury to other nerves and neighboring tissues are minimal. The postoperative period is easy and fast, the scars on the skin are almost invisible.

Depending on the localization of the problem area of excessive sweating, surgical access is lumbar (sweating of the legs) and thoracic (hyperhidrosis of the face, armpits, palms, upper body).

Lumbar sympathectomy is rarely performed, especially in men, due to possible damage to the nerves leading to the genitals and the development of impotence.

After endoscopic intervention, the stay in the hospital lasts no more than a few days. According to patients with sympathectomy, the effect develops immediately after surgery.

Recovery period does not require special appointments, the main thing is to carefully monitor your well-being. In order for the rehabilitation to be successful, it must be remembered that if severe sweating occurs in other parts of the body or if there is no effect from the operation, it is necessary to urgently contact the surgeon.

Lumbar sympathectomy is a surgical method for the treatment of hyperhidrosis, as well as chronic insufficiency arterial blood supply lower extremities by resection of the 2nd - 4th ganglion lumbar spinal column. Surgical intervention in such diseases is carried out using retroperitoneal access, but the most effective way treatment is the use of lumbar sympathectomy, which improves blood flow.

Indications for surgery

Indications for surgery, in addition to hyperhidrosis, are:

development of diabetic angiopathy;
obliterating endarthritis;
nonspecific arthritis of 1 and 2 stages;
Stage 3 post-phlebitic syndrome of deep venous disorders in the lower extremities;
obliterating atherosclerosis in the vessels of the lower extremities.

In addition, surgical intervention is possible as an additional method to reconstructive surgical interventions on the aorta and its branches, as well as in chronic arterial blood flow disorders (grades 2 and 3).

Technique for performing endoscopic sympathectomy

Contraindications for the procedure

Before making a decision on the use of surgery, the doctor must evaluate all possible risks of treatment.

Direct contraindications to the operation are:

diabetic diseases of any severity;
pathological disorders in the work of the endocrine system;
infectious- inflammatory diseases;
development of secondary hyperhidrosis;
severe course of pulmonary emphysema and pleurisy;
the presence in the patient's history of surgery on the abdominal organs;
symptoms of heart and respiratory failure.

Sympathetic fibers are clipped during the operation.

In addition, allergy testing is mandatory to avoid possible complications during the operation to cut (clipping) the sympathetic fiber.

Preparatory stage

Particular attention is paid to the preoperative preparation of the patient, which provides for a thorough examination using standard diagnostic methods:

collection of urine and blood for clinical analysis;
blood chemistry;
determination of the blood group and Rh of the patient's blood;
analysis for HIV infection, hepatitis, syphilis, etc.
In addition, a fluorographic examination is provided, as well as monitoring of the electrocardiogram.

Before the operation, some procedures are required. Among them - taking blood for analysis

The course of surgery

Standard surgery requires the use of epidural anesthesia or intubation anesthesia. The patient is placed in the same position as when performing a retroperitoneal discectomy, then the operating field is prepared for surgical intervention.

The incision is made parallel to the convergence of the oblique and rectus abdominis muscles, closer to the umbilical cavity. The depth of the cut is 10 mm. This allows you to define 1 port for inserting the endoscope.

At the initial stage, the surgeon performs digital exfoliation of the retroperitoneal space. The fasciae are then separated with a balloon dissector. With a sufficiently large size of the formed cavity, the balloon is removed and port 2 is installed for surgical instruments. Sometimes during the operation a retractor is used, which is inserted into the operated cavity after the formation of 1 port.

After opening the tissues of the retroperitoneal space, 2 additional trocars are inserted, which facilitate the work of the surgeon. Further, the retractor exfoliates the muscles from the peritoneum and retroperitoneal tissue, which provides access to the ganglia and sympathetic fibers.

At the final stage, the separation of the sympathetic ganglia with a dissector is performed. First, the sympathetic trunk is dissected with its simultaneous elevation above the nearby tissues, then the sympathetic stem branches are dissected, followed by the release of sympathetic ganglia.

Possible Complications

During any surgical intervention, various kinds of complications are possible, including when performing lumbar sympathectomy, which manifest themselves as follows:

bleeding is extremely rare, which can develop as a result of damage to the skin, large blood vessels and intercostal spaces;
if blood or air enters the pleural region, hemothorax or pneumothorax may develop;
with insufficient observance of the rules of asepsis during the operation, various kinds of infection are possible;
in the postoperative and rehabilitation period, compensatory hyperhidrosis may develop, which can proceed with such intensity that the removal of the clip is required. This can lead to the restoration of the function of the sympathetic trunk and the return of the original state;
may develop postsympathectomy pain symptom, change in taste, increased dryness skin, neuralgia and ejaculation disorders;
when the intrathoracic stellate ganglion is involved in the pathological process, the development of Horner's syndrome is possible, which is characterized by ptosis (drooping of the upper eyelid), narrowing of the pupil and retraction of the eyeball.

Most dangerous consequences sympathectomy - sudden cardiac arrest and anaphylactic shock.

Three main signs of Gordner's syndrome, as a complication after sympathectomy

It is important to note that in some patients, even after surgery, there is no positive effect, and in some cases, the symptoms can, on the contrary, intensify, which is explained by the presence of Kunz's nerves. However, there are practically no alternatives. Self-restoration of the removed segment of the sympathetic trunk is impossible. Statistics say that the complication occurs in 5% of all identified cases.

It must be taken into account that the number of sympathetic ganglia sometimes does not correspond to the number of vertebrae in the lumbar region. It is often possible to merge the ganglia into one node. Sympathectomy is performed only in case of ineffectiveness of other methods of treatment and is performed taking into account the course of the disease and individual features patient.

Expert review

Efficiency
Price
Safety
Duration
Recovery period

General opinion

Sympathectomy has been used for a relatively long time. Many patients have already experienced the results of the operation. I try to collect data that relate to a remote period, i.e. at least 8-10 years.

According to my observations, the effect of the operation is almost always. Rarely, but it happens that it is not.
Most often, we do thoracic sympathectomy for hyperhidrosis of the palms.

Many patients note that after some time some other parts of the body begin to sweat, but not much. This is called compensatory hyperhidrosis.

There is always a risk of relapse. Unfortunately, this does not depend on the specific method of carrying out the operation. Depending on the severity of the problem, repeated intervention or the use of conservative techniques is required.

3.6

Sympathectomy for hyperhidrosis is a surgical intervention that consists in a mechanical blockade of the transmission of nerve impulses along the sympathetic trunk, as a result of which the sweat glands stop working in a certain area of the body.

There are three methods for performing this operation:

traditional;
endoscopic;
percutaneous.

The traditional technique involves open access to the nerve trunk. To do this, the surgeon needs to make large incisions.

Naturally, such an intervention is very long, traumatic, accompanied by serious side effects and the formation of rough large scars.

Modern technology is different in many ways. It is called endoscopic, because. performed using video endoscopic equipment.

Its advantages are obvious:

due to the fact that only a few small incisions are enough, a good cosmetic effect is noted - completely inconspicuous scars are formed;
duration rehabilitation period most patients do not exceed one week

The essence of percutaneous technique is as follows. Through a small puncture with a thin needle, a chemical is injected into the nerve, or electrical destruction is performed. The procedure is not very convenient for the doctor, because. It is necessary to perform manipulations only under X-ray control.

Only the instrument is clearly visualized, but not the organs, vessels and nerves, which is why they are often injured. For this reason, such operations are not widely used.

Surgical treatment of hyperhidrosis is performed only when other, less invasive methods have already been tried!!!

Methods

The sympathetic trunk is part of the autonomic nervous system. It controls the activity of the sweat glands by sending nerve impulses to them.

Anatomically, it consists of several nodes, the so-called ganglia, which are located along the spine. They are connected to each other and to the spinal cord.

The purpose of sympathectomy for hyperhidrosis is to block nerve impulses that travel through the sympathetic trunk to the sweat glands.

This can be achieved in the following ways:

Destruction of nerve fibers by high-frequency current. This method has both advantages and disadvantages. On the one hand, you can quickly and radically stop the symptoms, on the other hand, when serious side effects it will not be possible to influence this, tk. such interference is irreversible;
Clipping. In this case, the fibers are not cut, but only clamped with special titanium staples. This is the preferred method as with the development of unwanted postoperative symptoms, you can remove the clamps and restore nerve conduction.

Endoscopic thoracic (thoracic) sympathectomy

it partial removal nerves located in the chest, responsible for stimulating the sweat glands. The removal, intersection or clipping of a part of the sympathetic trunk is performed. The indication is hyperhidrosis of the armpits, palms, head, face and neck.

Runs under general anesthesia and lasts no more than 90 minutes on average. Usually one or two incisions 1 cm long are made in the armpit.

Before dissection, the surgeon performs local anesthesia of the intercostal region, which significantly reduces pain in postoperative period.

Through a cut in chest an endoscope is inserted, and air is also pumped up so that the sympathetic trunk is well visualized. The nerve is blocked by the imposition of titanium clips or simply cut, due to which the impulses cease to reach the sweat glands.

Similar manipulations are performed on the other side.

At the end of the procedure, the air is evacuated, the wounds are sutured with absorbable sutures, which avoids the subsequent painful process of removing the sutures. Introduced into the chest drainage tubes, which are removed after a few hours, maximum within a day.

The patient needs hospitalization for 1-4 days. In the postoperative period, it is necessary to avoid heavy physical exertion for a month.

The success rate of thoracic sympathectomy for hyperhidrosis is about 90%. According to some reports - 95-98%.

Lumbar endoscopic sympathectomy

It consists in dissection or clipping of the sympathetic trunk in the region of the lumbar ganglia L3.4.

It is performed under general intubation anesthesia or epidural anesthesia. The skin incision is made on the side of the abdomen at the intersection of the rectus and oblique abdominal muscles. Its length is approximately 3-4 cm.

Then the subcutaneous fat is dissected, a gradual stratification of the tissues of the retroperitoneal space and the gradual introduction of the endoscope are carried out.

The sympathetic trunk is located very deep - between the aorta and psoas muscles (left), between the inferior vena cava and psoas muscles (right). This arrangement makes access to it not always convenient, and sometimes very difficult for the doctor.

Consideration should also be given to possible anatomical features patient or changes as a result, for example, experienced in the past inflammatory processes. This complicates the course of the operation.

In most cases, to ensure good effect it is necessary to remove 3-4 ganglia on both sides.

The procedure lasts about 1.5 hours.

Once the nerve is blocked, the feet stop sweating. This is observed in 99% of cases. Long-term results differ slightly. Some patients experience slight sweating after a few months.

What are the possible complications?

Sympathectomy for hyperhidrosis is associated with a certain risk. It does not depend on the technique and type of intervention.

Complications can be the following:

bleeding - are rare, but, nevertheless, their probability cannot be excluded. During thoracic sympathectomy, it may be caused by damage to the skin, intercostal spaces, or large blood vessels;
pneumo- and hemothorax - the ingress of air (blood) into the pleural cavity;
cardiac arrest during surgery;
infection;
compensatory hyperhidrosis - excessive sweating may occur in other places;
Horner's syndrome (with damage to the intrathoracic stellate node) - consists in the drooping of the upper eyelid, narrowing of the pupil, retraction of the eyeball. Usually its appearance is associated with too extensive surgical intervention, but it occurs very rarely;
postsympathectomy pain syndrome;
excessive dryness of the palms, which decreases over time;
taste disorders;
neuralgia, impaired ejaculation as a consequence of lumbar sympathectomy.

In some patients, there is no effect at all. Excessive sweating remains, and may even increase. In most cases, this is due to the presence of additional pathways, the so-called Kunz nerves.

However, most often, if sweating increases, it still does not reach the previous level. Alternative neural pathways in quantitative terms is not enough for this.

Restoration of the removed segment of the sympathetic trunk cannot occur.

As for compensatory hyperhidrosis, it can be so pronounced that you have to remove the clips. The sympathetic trunk in this case is restored, compensatory sweating disappears, but the primary problem also returns.

The clips can only be removed within three months after the operation. Later there are irreversible changes. Monitor your condition carefully. If there is severe sweating in other places, immediately contact your doctor!

According to statistical studies, complications are observed only in 5% of cases.

The preparatory stage and what may be contraindications

Before the operation, the patient must undergo a thorough medical examination.

As for the tests, they are standard for sympathectomy:

general analysis of blood and urine;
blood biochemistry;
determination of the group and Rh factor;
analysis for HIV, RW (syphilis), hepatitis A, B;
fluorography.

It is very important for the doctor to find out if there are any contraindications from the following list:

diabetes;
infectious diseases;
pathology of the endocrine system;
secondary hyperhidrosis;
surgical interventions in the abdominal cavity in history;
severe forms of pleurisy and emphysema;
heart and respiratory failure.

A sweating test is mandatory, with the help of which the sizes of hyperhidrosis zones are clearly determined. This determines the level at which the surgeon will cut or clip the sympathetic fibers.

Where is it made and how much does it cost?

Surgical treatment of sweating is performed in city general hospitals and private clinics.

In Moscow, the prices for sympathectomy for hyperhidrosis are completely different:

thoracic sympathectomy - open 10,000-50,000 rubles, endoscopic - 6,000 - 60,000 rubles;
lumbar sympathectomy - open 8,000-50,000 rubles, endoscopic - 15,000 - 88,000 rubles.

High-class equipment, modern anesthesia machines and, most importantly, experienced specialists - all this ensures high efficiency and safety of the operation!

UDK 616-072.1:616.832.14

L.E. Gylykov, B.Ch. Damdinov, B.A. Donirov

video endoscopy for lumbar sympTectomy

Republican Clinical Hospital named after ON THE. Semashko (Ulan-Ude)

The results of the use of videoendoscopic lumbar sympathectomy indicate its high efficiency, and. little trauma. The duration of surgical intervention and postoperative rehabilitation of patients is reduced, the likelihood of complications is reduced. This intervention is preferred over traditional operations, especially in patients with severe comorbidities. It may be recommended. as an independent method of treatment, and. as an addition to reconstructive operations, on vessels below the inguinal fold.

Keywords: video endoscopy, lumbar sympathectomy

videoendoscopy at lumbar sympathectomy

L.E. Gilikov, B.Ch. Damdinov, B.A. Donirov

Republican Clinical Hospital named after N.A. Semashko (Ulan-Ude)

The results of using videoendoscopic lumbar sympathectomy testify to its high efficacy and low traumaticity. Duration of surgical intervention and postoperative rehabilitation, and also the probability of complications are reduced. This intervention is preferable in comparison with traditional surgeries especially in patients with severe concomitant diseases. It may be recommended, as an independent method, of treatment and. as an addition. to reconstructive surgeries on vessels lower inguinal fold.

Key words: videoendoscopy, lumbar sympathectomy

introduction

In the last decade, there has been an increasing spread of endoscopic operations in operative surgery in many specialties. This is due to improvements in endoscopic surgical techniques that have proven to be superior in many areas, providing patients with greater comfort, better outcomes, and even fewer complications. However, in vascular surgery, especially in operations on the aorta, which usually require more free access, there are some concerns about the transition to this method. Nevertheless, one of the niches for the use of endoscopic operations in angiology is the performance of videoendoscopic sympathectomy.

Ganglionic sympathectomy is one of the most famous and widely used surgical interventions for the treatment of patients with obliterating lesions of the vessels of the lower extremities, introduced by Diez in 1924. It is believed that ganglionic sympathectomy eliminates angiospasm most completely and for a long time, eliminates or significantly reduces associated pain, thus affecting the main pathological links of obliterating diseases of the main and peripheral arteries (OMPA). The effectiveness of desympathization increases when it is combined with other pathogenetically substantiated operations.

However, traditional approaches to the thoracic and lumbar sympathetic trunks are highly traumatic (the need for thoracotomy during thoracic sympathectomy, crossing a large

muscle groups when performing extraperitoneal access for lumbar sympathectomy). Thus, various intra- and postoperative complications can initially be predicted: suppuration of wounds, pneumo- and hemothorax, damage to the vessels of the retroperitoneal space, the development of persistent intestinal paresis, retroperitoneal hematomas, intersection of the ureter, etc. The urgency of this problem is high for elderly and senile people, with significant comorbidities.

Therefore, the use of minimally invasive surgery, which includes videoendoscopic sympathectomy, may be an alternative method. surgical treatment patients with OZMPA.

material and methods

For the treatment of obliterating diseases of the arteries upper limbs Thoracoscopic thoracic sympathectomy has been successfully used in our department since 1996. Given the significant therapeutic and economic effect of this operation, we began to more actively implement the tactics of using endoscopic operations on the lumbar sympathetic trunk. Since 1999, endoscopic lumbar sympathectomy has been considered for all patients referred to our department for MAU of the lower extremities. The indications for surgery were the presence of obliterating endarteritis and obliterating atherosclerosis of the vessels of the lower extremities with a distal level of damage in patients. When selecting

patients for surgery were guided by the following criteria: the presence of a distal level of damage to the arteries of the lower extremities and a positive test with vasodilators during rheovasography. To objectify the degree of circulatory disorders in the lower extremities, we used rheovasography and ultrasonic dopplerometry of the vessels; if necessary, an X-ray contrast study of the vessels was performed. The degree of ischemia of the lower extremities was determined according to the Fontan classification modified by A.V. Pokrovsky. Patients who met the eligibility criteria were offered endoscopic surgery. After receiving an explanation, patients gave informed consent. Videoendoscopic lumbar sympathectomy was performed on endoscopic devices manufactured by Richard Wolf and Karl Shtorz.

VIDEOENDOSCOPIC LUMBAR SYMPATECTOMY TECHNIQUE

Videoendoscopic lumbar sympathectomy was performed under general anesthesia with the patient in the healthy side position using a roller. In the lumbar region along the mid-axillary line, using a 10-mm thoracoporter with optics under the control of the eye, a cavity was created in the retroperitoneal space under a gas pressure of up to 15 mm Hg. Art. Two 5 mm thoracoports were introduced into the formed cavity along the anterior axillary line, and then, using conventional clamps, access was made in a blunt way towards the spine and, accordingly, to the lumbar sympathetic ganglia. Ganglia at the level of L2 - L4 were isolated and cut off, after which hemostasis was checked, followed by gas removal, removal of instruments and skin sutures.

For the period 1999 - 2003. in the department of vascular surgery of the Republican clinical hospital More than 20 videoendoscopic lumbar sympathectomies were performed in Ulan-Ude in patients with obliterating diseases of the lower extremities. We studied the last 11 patients operated on by this technique, two of them on both sides (Group 1). For comparison, a group of patients operated in the same period according to the traditional open technique was taken with a total of 20 people (Group 2). The average age of patients in the 1st group was 53 (46 - 60) years, average age patients of the 2nd group was 54.5 (41 -65) years, that is, there was no significant difference in age (p = 0.74). Patients of both compared groups had grade 11B ischemia.

RESULTS

The duration of the intervention in the open method of lumbar sympathectomy was 45 (35 - 50) minutes. After the introduction of the videoendoscopic method of lumbar sympathectomy, the duration of the operation was

35 (20 - 45) minutes, but these differences are not significant (p = 0.12).

During surgery in group 1, two complications were recorded - pneumoperitoneum, which was later eliminated endoscopically, and intestinal paresis that arose after bilateral desympathization. In other cases, postoperative follow-up showed a significant reduction in pain associated with the operation, adequate restoration of intestinal transit, rapid general recovery. In the 2nd group, 6 complications were recorded, of which there was 1 suppuration of the postoperative wound, 4 postoperative intestinal paresis, 1 hematoma and 1 bleeding. However, there were no significant differences in the presence of complications in the 1st and 2nd compared groups (p = 0.25).

Due to the low invasiveness of videoendoscopic surgery, patients could move freely already on the second day and continue medical and physiotherapeutic treatment. Postoperative bed-day in the 1st group was 4 (4 - 4) days, in the 2nd group - 10 (8-14) days. The difference turned out to be statistically significant (p = 0.000007), which proves the pronounced economic effect of videoendoscopic sympathectomy.

DISCUSSION

Videoendoscopic manipulations in the retroperitoneal space, for obvious reasons, are accompanied by significant technical difficulties. To prevent complications during and after surgery great importance has a clear visualization of the main anatomical structures. To reduce the risk of injury main vessels, as well as the parietal peritoneum and ureter during lumbar sympathectomy, care must be taken when creating a cavity in the retroperitoneal space and mobilizing the sympathetic trunk, as well as ensuring complete visualization of the working part of endoscopic instruments during electrocoagulation, eliminating the possibility of contact with adjacent organs. Therefore, the qualifications and experience of the operating endoscopic surgeon are of great importance.

The immediate results of lumbar endoscopic sympathectomy are very encouraging. In almost all patients with OSMPA in the postoperative period, there is a clear positive trend, manifested in an increase in skin temperature, the disappearance of dyshidrosis, and a change in skin color. This proves its high efficiency, comparable to that of traditional access. In addition, after endoscopic lumbar sympathectomy, reconstructive operations on the arteries below the inguinal fold can be successfully performed with the restoration of the main blood flow. There is no doubt that all patients after sympathization should be under long-term regular monitoring with anti-relapse

course of medical treatment. The nature of the course and the prognosis of obliterating arterial diseases, as well as the timely and adequate choice of treatment tactics, largely depend on these factors.

Thus, the results of the use of videoendoscopic lumbar sympathectomy indicate its high efficiency and low trauma. The duration of surgical intervention and postoperative rehabilitation of patients is reduced, the likelihood of complications is reduced. This intervention is preferred over traditional operations, especially in patients with severe comorbidities. It can be recommended both as an independent method of treatment, and as an addition to reconstructive operations on the vessels below the inguinal fold. Good immediate and in most cases long-term results are the basis for the wider use of these operations in complex treatment patients with obliterating diseases of the vessels of the extremities of various etiologies.

literature

1. Gaibov A^. The role of ganglionic sympathectomy in the treatment of obliterating diseases of the vessels of the lower extremities Gaibov, D.D. Sultanov, M.Sh. Bahrudzinov UU Angiology and vascular surgery. - 2001. - V. 7, No. 1. - S. 70 - 74.

2. Kokhan E.P. Lumbar sympathectomy in the treatment of vascular diseases (history, problems, prospects) Kokhan, V.E. Kokhan, O.V. Pin-chuk. - M., 1997. - 125 p.

3. Kokhan E.P. Removal of intrathoracic sympathetic ganglia in the treatment of Raynaud's disease Kokhan, O.V. Pinchuk, A^. Fomenko UU Endoscopic surgery. - 1997. - No. 1. - S. 3 - 5.

There are the following types of sympathectomy: total sympathectomy, i.e. excision of the borderline sympathetic trunk over a considerable length; truncular sympathectomy - resection of the border trunk between two ganglia; ganglionectomy - removal of the sympathetic node; splanchnicectomy - resection of the splanchnic nerves and periarterial sympathectomy - resection of the outer shell of the arterial wall along with the nerves passing through it. Along with sympathectomy, there are sympathicotomy operations, which consist in crossing any section of the sympathetic nerve without its resection.

The therapeutic effect of these operations is to eliminate pathological impulses coming from the lesion and causing persistent foci of excitation in the central nervous system. During sympathectomy, the vessels in the sympathetic area expand. Concerning therapeutic effect most pronounced in diseases accompanied by vasospasm.

The main indications for the use of sympathectomy are vegetative pain syndromes, trophic ulcers, as well as pathological processes associated with peripheral circulatory disorders (obliterating endarteritis, Raynaud's disease, erythromelalgia).

After the operation, vasospasm in the affected limb disappears, swelling decreases, pain disappears, ulcers heal.

Sympathectomy for hyperhidrosis

Hyperhidrosis can be treated with surgery. One of the most famous methods is endoscopic sympathectomy. This is an operation to remove sweat glands: in this case, the procedure allows you to get rid of sweating problems forever, unlike ointments and powders, which give a temporary effect. Doctors insist that the treatment of hyperhidrosis should be started with a conservative method, and only when it showed a negative result, sympathectomy should be performed.

For radical and irreversible removal of excessive sweating, you can resort to surgery.

What is a sympathectomy?

Sympathectomy is the surgical removal of the sweat glands in order to stop the transmission of nerve impulses along the sympathetic fibers.

The method has been used for a long time, and the effect is maximum. It is worth noting that there have been cases of relapse, although they depend on the method of the operation and the use of a conservative technique. Sympathectomy allows the treatment of hyperhidrosis by affecting the sympathetic trunk. After certain manipulations, the sweat glands in specific areas of the body cease to function.

Indications and contraindications

Removal of sweat glands is a risk, therefore, the method is resorted to as a last resort, when other methods have been powerless. The indication is the presence of hyperhidrosis of different localization. It should be noted that at the beginning of the last century, lumbar sympathectomy was performed in the treatment of vessels of the lower extremities. But before the appointment of the operation, the doctors carry out complete diagnostics body, and if such diseases are detected, this method of treatment is contraindicated. These include:

diabetes;
violation of the organs of the endocrine system;
infections;
hyperhidrosis caused by another disease;
previous operations in the pelvis;
pleurisy;
emphysema;
insufficiency of the heart, lungs.

Back to index

Varieties of the operation

Sympathectomy for hyperhidrosis is a blockade of the nerve signal that sends the sympathetic trunk to the sweat glands. For this, apply various methods effects on the nerve: traditional, endoscopic, percutaneous and clipping. In addition, the types of operations are divided depending on the localization:

The traditional method is used very rarely, due to trauma and pain, since the method involves the operation using large incisions. It was replaced by an endoscopic system, which provides for small incisions, using modern equipment. The percutaneous method allows you to reduce the release of sweat in the axillary region. Its essence is to introduce chemical into the nerve. The method is not so widely used, as it is inconvenient for the doctor, it is quite traumatic. Clipping is a method in which the nerve node is blocked with special staples (clips). They can be removed over time.

Endoscopic type of operation

Endoscopic sympathectomy is an incomplete removal of the nerves that are located in the chest area, which are responsible for stimulating the work of the glands. The operation takes 90 minutes and is performed under anesthesia. At the same time, the chest remains intact and minimally injured, since the doctor inserts the endoscope device through a small incision, through which the sympathetic trunk becomes visible. The nerve is often blocked by clipping. After the operation, the patient needs rehabilitation. After the procedure, it is forbidden to lift heavy objects, engage in physical activity for a month. Indications for carrying out - hyperhidrosis of the upper body.

Thoracoscopic removal

Thoracoscopic surgery is performed less and less, as it is painful and traumatic, and there is a high risk of complications during and after the operation. This method removes the sweat glands through large incisions in the skin under the armpit. Given that the sympathetic trunk is in close contact with other organs, the doctor is forced to exercise extreme caution so as not to hook the lung, not to cause bleeding.

Lumbar removal

The procedure is similar to endoscopy, with the difference that they clip (sometimes dissect) the trunk in the lower back, or rather, the lumbar ganglion. Removal is performed under anesthesia or anesthesia, while incisions are made in the side of the abdomen. This procedure is long and difficult, since the sympathetic trunk is deep, in order to reach it, you will need to overcome the subcutaneous fat layer, exfoliate the peritoneal tissues, then gradually insert the endoscope. This operation allows you to get rid of excessive sweating of the legs and feet.

Operation

The course of the operation for endoscopic sympathectomy is carried out in several stages:

Local anesthesia of the area between the ribs is carried out, then the necessary manipulations with the endoscope.
When the device is inserted into the chest, air is pumped there so that the barrel is better visible.
A brace is applied to the nerve, or it is dissected, which interrupts the flow of the impulse.
Further, the air is pumped out, and similar manipulations are carried out on the opposite side of the sternum.
Wounds are sutured with surgical threads.

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Are there any complications?

Surgical intervention for hyperhidrosis is fraught with complications, among them are:

infection;
compensatory hyperhidrosis - the body's response to the operation, when another part of the body begins to sweat heavily;
postoperative pain syndrome;
severe dryness of the skin, especially in the area of \u200b\u200bthe palms;
neuralgia;
Horner's syndrome is rare, it is associated with the retraction of the eyeball, constriction of the pupil.

However, complications are not only observed after the operation, during the operation, the doctor may encounter pneumothorax or cardiac arrest. Pneumothorax occurs when air or blood enters the pleural cavity. In turn, bleeding, although not so common, can be caused by injury to the skin or blood vessels.

what is sympathectomy

SYMPATECTOMY [lat. (systema nervorum) sympathicum sympathetic nervous system + gr. ektome excision, removal; syn. sympathicotomy] - surgery- resection of the sympathetic nerve trunk (its nodes or branches).

There are total S. - removal of the border trunk with a chain of sympathetic nodes, partial - removal of the sympathetic node, truncular - resection of the sympathetic trunk, periarterial - removal of the carotid glomus, outer membrane or adventitia of the arteries, with sympathetic fibers passing through it, splanchnectomy - resection of the celiac nerves. In addition, preganglionic and postganglionic S. are distinguished. There are also unilateral and bilateral S., simultaneous and staged S.

S.'s purpose - interruption patol. centripetal impulses that create persistent foci of excitation in c. n. s., as well as a violation of the flow of centrifugal pathological impulses that can cause vasomotor spasm, circulatory disorders, humoral and trophic disorders in the lesion. As a result of S., under these conditions, vasodilation occurs, peripheral spasm is relieved, and collateral circulation in the sympathetic area improves. Under the influence of S., capillary circulation improves, the healing of trophic ulcers accelerates, areas of necrosis are limited, Foley decreases, and the inflammatory process subsides.

The page belongs to palliative methods of treatment. It is produced with obliterating lesions of the vessels of the extremities, Raynaud's disease, coronary disease heart disease, hypertension, disorders cerebral circulation. S. is also used for pain syndromes, causalgia, tabetic crises, sympathetic pain, pancreatitis, bronchial asthma, and scleroderma. S. A. Rusanov successfully used lumbar S. on the side of the lesion to combat imminent ischemic gangrene of the lower limb after ligation of the wounded main artery. In these cases, S. is appropriate if the novokaiiovy blockade of the lumbar ganglia gave a fairly clear, but short-term effect.

Contraindications to S. are the serious condition of the patient, cardiovascular and endocrine insufficiency, tuberculosis of the lungs and pleura (thoracic S.), inflammatory diseases of the chest and abdominal cavity. A relative contraindication to thoracic S. is kyphoscoliotic deformity of the spine with a costal hump.

Preparation for surgery and anesthesia are the same as for surgical interventions on the neck, chest and abdominal cavities. With cervical S. can be applied local anesthesia(see Local anesthesia), chest and abdominal S. is carried out under anesthesia (see Inhalation anesthesia).

To remove the upper cervical sympathetic ganglion (C1), a retromaxillary access is used (see Ganglionectomy, Ramicotomy). After exposure of the neurovascular bundle of the neck, the prevertebral fascia is opened and ramicotomy and ganglionectomy are performed. If more radical desympathization is necessary, the ganglionectomy is combined with denudation (see) carotid arteries and resection of the carotid glomus. The middle cervical sympathetic ganglion is found at the level thyroid gland. The inferior cervical sympathetic or stellate ganglion is removed by an anterior or posterior approach. With anterior access, a transverse supraclavicular or longitudinal incision is made, respectively, of the sternocleidomastoid muscle. The neurovascular bundle of the neck, the subclavian artery are exposed. In the depth of the wound behind the vessels, a stellate node is determined. After opening the pleurocostal ligament, it is removed.

S. in the thoracic region can be carried out extrapleurally and transpleurally, as well as during thoracoscopy (endoscopic S.). Extrapleural chest S. is carried out by a cut behind on the average line or paravertebral. After resection of the transverse processes and one or two adjacent ribs, the parietal pleura is exposed and the nodes of the sympathetic trunk are resected, which are located near the intercostal nerves. Transpleural S. is made by an incision along the IV intercostal space or a lateral axillary incision, followed by opening of the pleura over the sympathetic trunk. Endoscopic chest S. is carried out at a thoracoscopy (see) through the IV intercostal space on the average axillary line. After the introduction of the thoracoscope, the upper lobe of the lung is retracted downward and medially by the manipulator. Electrocauts-rum dissect the pleura and intrathoracic fascia. The sympathetic trunk is isolated with a manipulator, the connecting branches are crossed and the nodes are excised.

Lumbar S. is produced by transperitoneal and extraperitoneal accesses. With transperitoneal access, the abdominal cavity is opened (see Laparotomy). The parietal peritoneum is dissected, respectively, of the aorta or inferior vena cava on the side of the proposed C. With a single-stage ganglionectomy and resection of the superior hypogastric plexus, the incision is extended downward and medially. After bilateral ganglionectomy, the superior hypogastric plexus is resected at the aortic bifurcation. With extraperitoneal access, an incision is used outward from the rectus abdominis muscle or from the XI rib to the iliac crest.

In the postoperative period, anti-inflammatory and painkillers are prescribed, a set of measures is taken to prevent pneumonia, intestinal paresis, and cardiac disorders.

During S.'s carrying out various complications, mainly at the expense of operational errors are possible. After cervical S., paresis of the muscles of the neck and phonation disorders sometimes develop. When removing the stellate node, respiratory disorders and reflex cardiac arrest, damage to the thoracic lymph, duct are described. Thoracic S. can be complicated by pleurisy, hemothorax, and pneumonia. At endoscopic chest S. damages of lungs, intercostal arteries, hemothorax, pleurisy are described. At lumbar S. damages of ureters, formation of a retroperitoneal hematoma are possible, intestinal paresis quite often develops.

The nearest results of S., according to various data, are characterized by the expressed to lay down. effect in 50-80% of cases. Long-term results are not always positive. The best outcomes of S. are noted at functional changes; at organic lesions, in cases of the expressed trophic frustration, S.'s effect is much weaker.

Bibliography: Ivanov I. A. Adrenal and sympathectomy for obliterating diseases of the vessels of the lower extremities, Owls. honey., No. 1, p. 72, 1979, bibliogr.; Kokhan E. P., Zobnin I. V. and Mironenko A. A. Long-term results of lumbar sympathectomy in patients with obliterating atherosclerosis of the lower extremities, Surgery, No. 1, p. 59, 1979; Mikhailoven and y V. S. Surgical interventions on the vegetative nervous system with indomitable pain in the pelvic region, Vopr. neurosurgery, L ‘- 3, p. 35, 1967; Nesterov S. S., 0 in h and N II and to about in V. A. and M and from Ilii about in K. N. Lumbar sympathectomy in the treatment of obliterating diseases of the arteries of the lower extremities, Surgery, Li 2, p. 23, 1978; Rusanov S. A. Recognition and treatment of gunshot wounds of the blood vessels of the extremities, M., 1954; Fokin A. A., Shapiro M. Ya. and Verbovec to and y JI. P. Endoscopic thoracic sympathectomy, Gr\tdn. hir., No. 4, p. 77, 1976; M a t-t a's s i R., Miele F. a. D'Ange- 1 o F. Thoracic sympathectomy, J. cardiovasc. Surg. (Torino), v. 22, p. 336, 1981; S e b e s t e n y M. u. a. Spater-gebnisse der thorakalen Sympathektomie b ei verschiedenen Krankheitsbildern, Acta chir. Acad. sci. hung., Bd 19, S. 69, 1978.

Thoracic sympathectomy: the nuances of the operation

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Constantly and excessively sweaty palms are an unpleasant and quite common phenomenon. There are several ways to deal with this problem. The most common surgical treatment is thoracic sympathectomy. However, despite its simplicity, the operation has its own nuances. In more detail about them, and why it is so important that this procedure is performed by a thoracic surgeon, we are told by the head of the Hyperhidrosis Treatment Center in Moscow, Ph.D. Kuzmichev Vladimir Alexandrovich

- Vladimir Alexandrovich, in what cases is thoracic sympathectomy performed?

Thoracic sympathectomy is only considered when conservative methods fail. The main ones are concentrated medical antiperspirants, iontophoresis and botulinum toxin (Botox) injections. The latter are the most effective and allow you to cope with hyperhidrosis. strong degree expressiveness. At the same time, the feature given treatment is that it does not have any side effects.

However, there is a group of patients who manage to cope with palmar hyperhidrosis only with the help of surgical methods, more specifically with the use of endoscopic thoracic sympathectomy. This applies, first of all, to people with fairly strong sweating of the palms, and to those who have not been sufficiently helped by iontophoresis.

This group also includes those patients for whom botulinum toxin injections are not available for financial reasons, or their effect is too short.

Thoracic sympathectomy is also indicated for redness of the face, the so-called Blushing Syndrome, erythrophobia. However, it is worth considering the fact that it does not help with all forms of redness, but only with very specific ones.

The third type of indication may be pain syndromes in the extremities, due to previous injuries. Thoracic sympathectomy is also used as an auxiliary method, for example, after nerve transplant surgery for trauma. In this case, it helps their regeneration.

- Is such an operation covered by the CHI policy?

In Russia, hyperhidrosis itself, whether axillary or palmar, is not included in the list of diseases whose treatment is covered by an insurance policy. Accordingly, endoscopic thoracic sympathectomy is not included in the list of diseases provided by regional standards. Plus, when performing a sympathectomy, it is important to understand who should have it and who should not.

- And in what cases it is impossible to carry out a sipatectomy?

Contraindications to thoracic sympathectomy are built on the basis of the expected risks of side effects of the operation. In particular, the leading risk in sympathectomy is trunk sweating. Accordingly, it is highly undesirable to perform this operation in such patients. An additional functional contraindication is the presence of a rare pulse in patients. This is due to the fact that the operation itself leads to a decrease in heart rate, and if a person has an initial rare pulse, then the operation will only exacerbate the problem.

It is forbidden to carry out sympathectomy and professional athletes or those whose work is associated with a large aerobic load. I have often refused professional athletes who are in a state of active period of their career.

Naturally, general diseases also belong to contraindications. This also includes previous serious pneumonia and lung surgery. This is due to the fact that an adhesive process occurs, which complicates the operation.

- When did sympathectomy begin to be practiced in Russia?

Sympathectomy has been performed episodically for over 20 years. This operation became widespread somewhere in the early 2000s, and we are the pioneers of this technique in our homeland.

Abroad, the first operation was performed in the late 1940s in Germany by the Austrian surgeon Kuks. But endoscopic sympathectomy became widely used in the early 1990s. The clinic in Sweden was the distributor of technology all over the world. Therefore, at present, this procedure is used in almost all countries.

- How long have you been practicing thoracic sympathectomy?

- Do you agree with the opinion that only thoracic surgeons should perform sympathectomy?

Yes, absolutely. Since only a thoracic surgeon can assess the condition of the lung, adhesions and pneumostasis. An ordinary surgeon does not have the data characteristic of the first, experience. Hence, incorrect judgments, conclusions, and a method of treatment arise, which leads to poor results of the operation.

- And what clinical cases from your practice confirm the arguments that endoscopic sympathectomy should be performed by thoracic surgeons?

In this case, the experience of thoracic surgery makes it possible to recognize certain situations in which the principle of the operation changes.

For example, about 1 in 500 patients has a condition such as the lobe of the azygos vein. This is a rather rare anomaly, which is characterized by the presence of a fibrous membrane covering the upper thoracic regions sympathetic trunk. We have encountered this situation twice. Naturally, since we had the necessary experience, the operation went without problems. However, if the operation was not performed by a thoracic surgeon, then I am almost 100% sure that this manifestation would not have been noticed.

Or sometimes, adhesive processes are found in the operated person. It is enough for us to immediately determine how much the operation will be surmountable, and what needs to be done in order to secure the patient's condition.

- And if, nevertheless, an unsuccessful sympathectomy was performed, is it still possible to correct the unsatisfactory result?

It is possible to repeat the operation. In our practice, we have repeatedly had to re-operate, analyze case histories and observe such patients who underwent surgery by inexperienced surgeons who are not thoracic. It is extremely disappointing that in cases where the operation could be performed without injuries and complications, secondary operations had to be performed and the consequences of completely ridiculous interventions had to be resolved.

- What are the most important nuances of the operation that you can name, having been practicing it for many years?

First of all, it must be said that this operation is of a quality of life, so the patient must be insured against the slightest complications. Pain in the postoperative period should also be minimized. A very important nuance is the correct anesthesia. But the most important thing in this case is the selection of patients. By following sufficient experience, we are more likely to be able to predict which patient will have severe side effects and dissuade him in certain cases from surgery.

Finally, the operation must be done technically correctly. In our practice, it was such that we had to redo operations performed by non-thoracic surgeons 4 times (in one case - by an endoscopic general surgeon, in 3 others by plastic surgeons and urologists) - when they simply did not find the nerve, but instead damaged the accessory nerves, which led to severe dysesthesia on the hands.

Firstly, thoracic sympathectomy should not be considered as a panacea and as the first method of getting rid of the problem of palmar hyperhidrosis. Opportunities need to be carefully considered conservative treatment and consider the risks of side effects. Secondly, you must definitely get several opinions and choose the right surgeon. Only thoracic and only in a clinic equipped with special equipment.

Thank you, Vladimir Alexandrovich, for the detailed story!

Endoscopic sympathectomy - thoracic and thoracoscopic

You will learn what a sympathectomy is, when it is performed, and what is the difference between endoscopic thoracic and thoracoscopic surgery. We will also consider prices and reviews for such treatment.

Among other things, I will tell you for what diseases such an operation is performed, what are the indications and contraindications. Let's touch on the course of the operation and the possible risks to the patient's health.

What is a sympathectomy

A sympathectomy is a surgical operation to block nerves in the sympathetic nervous system.

Sympathetic nervous system

As a rule, it is carried out in two main cases:

For hyperhidrosis (excessive sweating)
With atherosclerosis of the lower extremities (done to increase blood flow)

Below we consider these two main tasks in more detail.

Endoscopic sympathectomy for hyperhidrosis

Endoscopic sympathectomy is an operation that is used in the extreme severity of palmar hyperhidrosis and stress reddening of the face.

The operation itself has been proposed for a long time. Back in the late 19th century. However, at that time it was used for the widest range of indications and, moreover, not always effectively.

The first uses against hyperhidrosis were carried out in the 20s of the last century. However, sympathectomy began to be widely used only with the introduction of thoracoscopic techniques.

In the beginning, there were primitive thoracoscopes with no serious optical effort. However, with the use of modern endoscopic equipment, such operations have become much easier, safer and without complications.

Currently, the operation uses thin endoscopes, good magnifying optics and excellent instruments. All this makes the operation the safest in qualified hands.

Operation Requirements

Modern sympathectomy operations are based on several provisions:

It should be performed by a thoracic surgeon. Whatever other surgeons who undertake this operation may say, there is a potential risk of complications. In this case, only the experience of a thoracic surgeon can save the patient from very serious problems.
The operation should be performed in the presence of a qualified anesthesia team. Although the operation is quite fast. However, in the process of its implementation, certain changes in the rhythm of cardiac activity and a decrease in oxygen consumption are possible. The anesthesiologist must be prepared for such turns in advance.
The operating room should be equipped with good endoscopic equipment. Since the operation is carried out on very small structures, clear visibility and excellent magnification are required.

How is a thoracic sympathectomy performed?

Endoscopic thoracic sympathectomy (also called thoracic) is performed under general anesthesia and on both sides. Sometimes the patient is told that we will perform the operation on one side. Then you will stay with the drainer of the day and then you will be discharged. And after some time (1 - 6 months) we will perform the operation.

Endoscopic thoracic sympathectomy

Now, if you were told this, then I would warn you against having an operation in such clinics. Because they clearly do not have modern knowledge in this field of surgery.

Sympathectomy can always be performed in one step. Exceptions can only be made in very rare cases, which we will discuss below.

In general, the operation begins with the introduction of carbon dioxide into the chest (into the pleural cavity). Due to this, the lung falls and moves away from the top of the pleural cavity. As a result, the nerve is exposed. It needs to be considered, selected and then either crossed, or its section removed, or riveted.

The need for such a precaution is due to the fact that one of the undesirable side effects of sympathectomy is the risk of developing severe sweating of the trunk. The so-called compensatory hyperhidrosis.

With palmar hyperhidrosis, he does not bother so often. However, at least 4% of patients operated on for palmar hyperhidrosis experience very severe trunk sweating. It creates even more problems for patients than with palm sweating.

After completing the operation on one side, the surgeon straightens the lung and leaves no drains (tubes in the pleural cavity) except in certain cases. For example, if adhesions are expressed in the pleural cavity.

Thoracic sympathectomy on the other hand is performed in the same way. A feature may be that when performing the second stage, the anesthesiologist may note a slight decrease in blood oxygen saturation. But this is then very quickly compensated.

In this second stage, there is also a decrease in heart rate, which is a direct consequence of sympathectomy.

Postoperative period

In the postoperative period, patients require rest and control x-ray studies. In some cases, ultrasonic testing may be used.

But the next day, the severity of the pain is significantly reduced. Most patients leave without the need for pain medication. And during the day, the pain usually disappears completely.

The incisions in endoscopic sympathectomy are minimal. Therefore, after removing the sutures and after months, they turn white and become almost invisible.

Sympathectomy for facial redness

Facial flushing techniques may be considered for other indications for sympathectomy. In this case, the operation is carried out according to several other requirements. It is carried out higher in a more risky area for an inexperienced surgeon.

This operation is more responsible. Therefore, before conducting it, be sure to find out the reputation of this clinic and its doctors.

Severe compensatory hyperhidrosis occurs in almost 9% of patients.

Sympathectomy for both palmar hyperhidrosis and stress facial flushing is the last resort. In any case, all possibilities for conservative therapy should be tried to avoid surgical intervention.

But if the need for such an operation persists, then it is better to contact clinics that already have significant experience in conducting this treatment. There must also be a surgeon who will be ready for anything. potential problems encountered during the operation.

Why is thoracoscopic sympathectomy dangerous?

Thoracoscopic sympathectomy is the traditional method for manipulating the sympathetic nerve trunk. That is, the skin and muscles in the neck are cut, which gives a very extensive access to the nerve.

The endoscopic option is safer and does not leave noticeable scars. For comparison, with this method, an incision of less than one centimeter is made. More modern equipment is also used, due to which health risks are reduced.

Lumbar sympathectomy is a palliative method for the treatment of diseases of the blood supply to the extremities, accompanied by ischemia, intermittent claudication and trophic disorders. The method allows to improve blood circulation without intervention on the main vessels.

Lumbar sympathectomy for atherosclerosis of the lower extremities

Atherosclerosis of the lower extremities
Trophic ulcers of the legs
Diabetic macroangiopathy
Endarteritis, etc.

By itself, sympathectomy involves switching off from the normal operation of the nerve nodes responsible for the narrowing of peripheral vessels.

Previously, such interventions were part of an intervention on the arteries or were performed independently. For this, open surgery methods were used, and the access itself was performed under general anesthesia.

Given that the sympathetic nodes lie on the anterior surface of the spine, the surgeon had to go deep enough. As a result, there were complications from anesthesia, surgical access, from a long stay in the hospital, and so on.

To date, a modified technique of sympathectomy for atherosclerosis of the lower extremities is used. It is carried out under the control of a computer tomograph.

Doctors aimingly and very accurately puncture the area of the node. Next, a neurolytic drug is directly injected, which completely disables the node from normal functioning.

Administration of a neurolytic drug

The consequence of this procedure is to disable the narrowing effect on the vessels. As a result, the vessels dilate and fill with blood.

We see the first effects in the first 30 minutes. The legs begin to warm up, the pain syndrome decreases, the blood supply to the limbs improves.

Indications for sympathectomy surgery

Indications for sympathectomy are some diseases of the arteries and some diseases of the veins with trophic changes.

First of all, this technique is used for patients who cannot go for open interventions for bypass surgery, arterial prosthetics.

The fact is that the method refers to indirect vascularization and the main arteries are not involved in this situation.

What are the risks?

The sympathetic ganglion is located in close proximity to large vessels such as the aorta and lower vena cava. Therefore, the implementation of this method of treatment is accompanied by the risk of bleeding.

The next contraindication is nerve root injury. It all depends on accuracy. If the nerve root is damaged, then sensitivity may be turned off. As a rule, pain syndromes do not occur.

Also given that various drugs are used in this procedure, anaphylactic reactions may develop. Basically, on local anesthetics. Individual reactions to iodine and iodine-containing preparations used during the procedure may also develop.

Also to side effects risk may include damage around underlying organs such as the renal pelvis, ureters, and so on. Infection is also a risk. Therefore, the procedure must be performed under aseptic conditions.

Pneumothorax is also a risk. Occurs if there is work on high-lying sympathetic nodes. Or it occurs in case of significant spinal deformities such as scoliosis, spinal hernia, and so on.

In some cases, neuralgia occurs along the nerve root and neuropathies may occur along the anterolateral surface of the thigh. This phenomenon disappears on its own within a month.

In the case of a complete block of sympathetic nodes on both sides, men may experience dry orgasm and ejaculation disorders.

Contraindications for sympathectomy

To whom we cannot perform sympathectomy and what are the contraindications? If the patient has lesions chronic infection(infected gangrene or ulcers), then due to the risks of spreading infections, such a procedure is very dangerous to carry out.

If the patient had a stroke or heart attack over the next three months, there is a risk of relapse. In this case, the person is first taken to rehabilitation and only after that this procedure is carried out.

If the patient has claustrophobia, then he should immediately be warned that a long stay in a confined space is required. Therefore, considering the possibility panic attacks, not every doctor will be able to admit such patients to treatment.

Patients with grade 3 heart failure may have cardiac decompensation. Therefore, for this type of pathology, doctors will not take surgery.

There is also a ban in case of manifestation allergic reactions medications used during the procedure.

It is also contraindicated if you are taking anticoagulant drugs. For example, fraxiparin, clexane, warfarin, xarelto, prodaxa, etc. After all, then the procedure will be associated with significant bleeding and the formation of hematomas.

Advantages of sympathectomy for atherosclerosis of the lower extremities

Let's take a look at the benefits of sympathectomy for atherosclerosis of the lower extremities. In normal clinics, this method is classified as minimally invasive. Therefore, it has enough a large number of advantage over open surgery.

Firstly, this is the lack of extensive surgical access. Accordingly, the number of infections that are predicted in a patient is much less. There is also no anesthesia and its risks. The procedure itself is performed under local anesthesia.

The procedure itself does not require much preparation, except that doctors ask the patient not to eat in advance. And in case of any manifestations of fear or nervousness, doctors are asked to take sedatives in advance.

The course of the operation of the lumbar sympathectomy

Now let's talk a little about the operation of the lumbar sympathectomy. As a rule, the patient in the supine position is fed into the CT scanner. Next, doctors mark the spinous processes of the lumbar vertebrae, perform a primary scan, and mark the area where the needle and conductor are passed.

Marking the puncture zone

After that, a needle puncture is performed, control of the introduction of an antipsychotic drug and control of entry into the node destruction zone.

After the procedure, with which patients can leave on their own, doctors conduct additional studies. They note how effective the operation was.

After the procedure, the limb should warm up. There should be a feeling of filling the veins and the pain syndrome should decrease. As a rule, after sympathectomy for atherosclerosis of the lower extremities, this effect occurs in almost all patients.

Thus, if there is a need to restore blood circulation, sympathectomy can only be used as additional method to treatment. And given that it gives good results, the overall results of treatment can improve significantly.

Sympathectomy price

The price of sympathectomy varies. It all depends on the clinic, its equipment, doctors, and so on. Location also plays a role. In some areas, prices can be inflated several times.

As a rule, in such clinics the equipment is not too dead. Yes, doctors are experienced. After all good doctors There are additional fees for services. And if you are treated in cheap clinics, then there will be a high probability of poor treatment.

Now you know what a sympathectomy is. Choose the endoscopic thoracic method. Thoracoscopic is more dangerous to health.

Be sure to consider all risks, indications and contraindications. Not everyone is eligible for the operation. Also, before undergoing such treatment, I recommend that you first try conservative methods.

If you urgently need such an operation, then take care of choosing a good clinic. Don't go for cheapness. If the budget does not allow, then try to take the average prices. Also, before applying for treatment, be sure to collect all the information about the clinic. In general, be healthy!