Laparoscopic lumbar sympathectomy feasible, safe with less postoperative complications in Critical limb-threatening ischemia: Study
A study published in BMC Surgery suggests that laparoscopic lumbar sympathectomy is feasible, safe, and has fewer postoperative complications in Critical limb-threatening ischemia.
The treatment of critical limb-threatening ischemia (CLTI) is revascularization. Lumbar sympathectomy (LS) could be attempted when this is not amenable. Using laparoscopic techniques to perform LS adds the advantages of minimally invasive surgery. Twenty-four patients, presenting with non-reconstructable CLTI and rest pain, were randomly divided into group I (14 patients) who underwent retroperitoneoscopic lumbar sympathectomy (RPLS) and group II (10 patients) who had conventional open lumber sympathectomy (COLS). Results: RPLS patients had shorter hospital stays, fewer intraoperative complications, and less postoperative pain. However, the mean operative time was significantly longer (86.4 ± 9.1 min, p-value: 0.02) in the RPLS group but decreased with each subsequent case after that. The differences in post-operative capillary refill time, ABI, TBI, and TcPO2 were not statistically significant between both groups (p-values: 0.97, 0.13, 0.32, 0.10, respectively). However, the difference in the quality-of-life score was statistically significant; the mean (± SD) SF-36 score increased from 48 ± 6.8 to 81 ± 4.4 (p-value < 0.001) in RPLS group compared to 52 ± 8.8 to 59 ± 1.2 (p-value: 0.52) in COLS group. RPLS is feasible, safe, and has the advantages of minimally invasive surgery: minimal blood loss, less intraoperative complications, shorter hospital stay, and less postoperative pain. However, the operative time in RPLS cases is longer than in the COLS; training on the procedure is recommended to improve the learning curve.
Reference:
Shaalan, W.E., Elemam, A.A., Lotfy, H. et al. Laparoscopic versus open lumbar sympathectomy in critical limb threatening ischemia patients in Egypt. BMC Surg 24, 350 (2024). https://doi.org/10.1186/s12893-024-02618-6
Keywords:
Laparoscopic, lumbar sympathectomy, feasible, safe, less postoperative, complications, Critical, limb-threatening, ischemia, study, BMC Surgery, Shaalan, W.E., Elemam, A.A., Lotfy, H, Sympathectomy, Laparoscopic surgery, Chronic limb-threatening ischemia, Laparoscopic sympathectomy, Lumbar sympathectomy, Sympathetic denervation, Laparoscopy, Peritoneoscopy, Laparoscopic assisted surgery, Critical limb ischemia, Peripheral artery disease, Peripheral arterial disease
