SYMPATHECTOMY, LUMBAR

General Information

DEFINITION-Removing a section of the sympathetic nerves located near the spinal cord in the lower back.

BODY PARTS INVOLVED-The lumbar sympathetic nerves (part of the autonomic nervous system) that control contraction and expansion of small arteries in the legs.

REASONS FOR SURGERY

• Restoration of normal blood supply to the legs. Removing part of the sympathetic nervous system stops spasms in the blood vessels that can cause or aggravate partial obstruction and cause severe pain.
• Non-healing ulcers in legs or feet.

SURGICAL RISK INCREASES WITH

• Obesity; smoking; chronic illness.
• Atherosclerosis or diabetes mellitus.
• Use of drugs such as: antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta-adrenergic blockers; or cortisone.
• Use of mind-altering drugs, including: narcotics; psychedelics; hallucinogens; marijuana; sedatives; hypnotics; or cocaine.

What To Expect

WHO OPERATES-General surgeon, neurosurgeon or vascular surgeon.

WHERE PERFORMED-Hospital.

DIAGNOSTIC TESTS

• Before surgery: Blood and urine studies; lumbar sympathetic nerve block.
• After surgery: Blood studies.

ANESTHESIA-General anesthesia by injection and inhalation with an airway tube placed in the windpipe.

DESCRIPTION OF OPERATION

• A large incision is made, extending from the abdomen around the flank, almost to the backbone. The muscles are separated.
• The lumbar sympathetic chain of nerves is located, cut free and removed.
• The muscles are sewn together with large sutures.
• The skin is closed with sutures or clips, which usually can be removed about 1 week after surgery.

POSSIBLE COMPLICATIONS

• Excessive bleeding.
• Surgical-wound infection.
• Incisional hernia (rare).
• Inadvertent injury to the ureter (rare).
• May result in impotence.

AVERAGE HOSPITAL STAY-7 days.

PROBABLE OUTCOME-Expect complete healing without complications. Circulation will improve in 3 to 4 days. Allow about 4 weeks for recovery from surgery.

Postoperative Care

† Move and elevate legs often while resting in bed to decrease the likelihood of deep--vein blood clots.

† You may use non--prescription drugs, such as acetaminophen, for minor pain.

† To help recovery and aid your well--

being, resume daily activities, including work, as soon as you are able.

• Avoid vigorous exercise for 6 weeks after surgery. Start a walking exercise program when your doctor prescribes it. > Resume driving 18 days after returning home. > Resume sexual relations when your doctor determines that healing is complete.

DIET-Clear liquid diet until the gastrointestinal tract functions again. Then eat a well--balanced diet to promote healing.

Call Your Doctor If

† Pain, swelling, redness, drainage or bleeding increases in the surgical area.

• You develop signs of infection: headache, muscle aches, dizziness or a general ill feeling and fever.
• You experience new symptoms, such as nausea, vomiting, constipation or abdominal swelling.
• Your foot becomes cold, discolored or numb.