Comparison of minimally invasive procedure with the standard open approach for lumbar sympathectomy

Abstract

Aim: To compare minimally invasive procedure with the standard open approach for lumbar sympathectomy and to assess the morbidity and evaluate the outcome in terms of operative time, blood loss, complications and recovery time. Method: The present study was carried out as a prospective cross-sectional observational study. A total of 60 patients were enrolled in the study who were divided into two groups A and B of 30 each who were operated by open method and laparoscopic method respectively.Patients between age 17 to 80 years with ischemic rest pain that requires continuous analgesia for > 2 weeks, ischemic foot ulcers that failed to heal for > 6 weeks and distal gangrene which is limited to the fore foot were included in the study. Result. In group A total 18 out of 30 patients(60%) and in group B total 21 out of 30 patients(70%)were taking analgesics for pain from more than 4 weeks. In group A operative time in 6 patients was ½-1hr, in 20 patients 1-1½ hrs and in 4 patients operative time was more than 1½ hrs while in group B in 22 patients operative time was ½-1 hr, in 6 patients 1-1½ hr and in 2 patients it was more than 1½ hrs.P value was 0.0002 which was significant. In group A there were ureteric injury in 2 patients, venacaval injury in 1 patient, peritoneal perforation in 1 patient, wound haematoma in 7 patients, wound infection in 6 patients and incisional hernia in 2 patients as intra operative and post operative complications while in group B there was ureteric injury in 1 patient, peritoneal perforation in 1 patient, wound haematoma in 1 patient, wound infection in 2 patient and there was no vena caval injury and incisional hernia as intra operative and post operative complications. P value was 0.02 which was significant. In group A 4 patients recovered in 5-7 days and 26 patient took more than 7 days to recover while in group B 5 patients recovered in 3-5 days,20 patients recovered in 5-7 days and 5 patients took more than 7 days to recover.P value was 0.006 which was significant. Conclusion: In minimally invasive technique of lumbar sympathectomy operative time,intraoperative complications were much less and recovery was significantly faster as compared to classical open method.