The aim of the operation is to divide the second or third lumbar sympathetic ganglion. The surgeon reaches the sympathetic chain through the retroperitoneum (the space behind the abdominal cavity) and works along the front of the muscles at the back of the abdomen. The scars are on the side of the abdomen.

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The success rate is 98% to 100%. The overall risk of complications is low. Possible complications include the following.

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• Pain after surgery, which is usually temporary and may sometimes affect the legs.

• Retrograde ejaculation, where semen passes into the bladder during orgasm, is very rare. It was a common complication when open surgery involving extensive nerve removal was used to treat chronically reduced blood flow to the legs. With keyhole surgery and division of the sympathetic chain below the level of the second lumbar vertebra (L2), this risk is exceptionally low. This is separate from erectile function, which the procedure is not expected to affect.

• Compensatory sweating is the most common side effect, affecting more than half of patients. It is less common after lumbar sympathectomy than after thoracic sympathectomy. For most patients, it is much less disruptive than the original excessive foot sweating.

• Warmth and swelling in the legs are common and usually temporary.

• Other, less common complications include blood clots in the leg veins, vaginal dryness and infection at the surgical site.

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Lumbar sympathectomy is the most effective treatment for excessive foot sweating (plantar hyperhidrosis), with excellent short-, medium- and long-term results. As with any operation, there are risks, although complications are generally minor and temporary.

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This operation is offered only to patients whose symptoms have persisted despite appropriate non-surgical treatment, including trials of both topical treatments and iontophoresis.