Retroperitoneoscopic lumbar sympathectomy for the treatment of primary plantar hyperhidrosis

A multicentre retrospective study of lumbar sympathectomy for plantar hyperhidrosis: satisfaction and postoperative complications

BACKGROUND

Primary plantar hyperhidrosis has a severe impact on quality of life and conservative treatments are only effective in the short term. Thoracic sympathectomy has proven its effectiveness in the treatment of palmar hyperhidrosis, but lumbar sympathectomy for plantar hyperhidrosis remains poorly described.

OBJECTIVES

To report the satisfaction of patients with primary plantar hyperhidrosis treated with mechanical lumbar sympathectomy as well as their postoperative complications.

METHODS

This was a multicentre retrospective observational study of 16 patients with primary plantar hyperhidrosis, treated with mechanical lumbar sympathectomy from December 2012 to October 2022. Patients' characteristics were collected from medical records. Quality of life, postoperative satisfaction and complications were evaluated using a standardized questionnaire.

RESULTS

Lumbar sympathectomy was performed on 16 patients, 14 were women and 2 were men with a total of 31 procedures. Fourteen (88%) patients were satisfied and would recommend the surgery to other patients. Compensatory hyperhidrosis occurred in 75% of patients, recurrence of hyperhidrosis in 31% and sexual dysfunction in 19%.

CONCLUSIONS

Lumbar sympathectomy provides satisfying results for plantar hyperhidrosis with acceptable postoperative complications, regardless of sex. Compensatory hyperhidrosis was the most frequent complication but had no impact on patient satisfaction. In the literature, data on the risk of sexual dysfunction are reassuring and in our study only one of two men experienced transient ejaculation disorder.

The Impact of Hyperhidrosis on Quality of Life: A Review of the Literature

Hyperhidrosis is a condition of excessive sweating, which can have profound physical and mental effects. Hyperhidrosis is a significantly impactful and distressing illness that warrants equal attention as other more well-known dermatologic conditions. However, because of a lack of awareness among the public, stigma, and difficulty with access to treatments (due to cost or insurance coverage), patients are less likely to be diagnosed and treated. In hyperhidrosis, quality-of-life surveys can be useful for determining the magnitude of symptoms and to evaluate treatment outcomes. The purpose of this study was to conduct a narrative literature review to investigate the impact of hyperhidrosis on quality of life. A total of 49 articles investigating the impact of primary hyperhidrosis on quality of life were selected for the review. Hyperhidrosis is a potentially debilitating illness that affects multiple domains of patients' lives including their psychological, physical, and social functioning. Despite the significant impacts, patients with hyperhidrosis are less likely to seek care. Here, we explore these impacts, and disparities in care, in more detail.