Published: 2020-01-27

Conventional versus invagination stripping varicose veins: which is better?

Varun Sudarshan Shetty, Iqbal Ali, Varugu Suryateja Reddy


Background: Varicose veins are dilated, tortuous veins. It is an extremely common condition causing substantial morbidity. Prevalence of varicose veins ranges between 5% to 30% in adult population. Surgery is preferred over conservative treatment in symptomatic primary varicosis of the great saphenous vein (GSV). This study aims to compare the efficacy of GSV stripping by invagination technique in comparison to the conventional method in terms of time taken to strip the vein, the length of vein stripped, post-operative pain, area of bruising and intra-operative blood loss.

Methods: The study was conducted in Dr. D. Y. Patil Medical College, Hospital and Research Centre located in Pimpri, Pune between July 2017 to September 2019.It is a prospective comparative Study. Subjects were randomly divided into 2 groups alternately where group A and B were operated by conventional and invagination techniques respectively and their outcomes were compared.

Results: The mean age of the cases in Group A (conventional stripping) was 52 years and in group B (Invagination stripping) was 53 years. Blood loss was significantly more in conventional stripping compared to invagination stripping (p<0.001). The post-operative (after 1 week) mean VAS of the cases in Group A was 3.1 and 2.3 respectively while in group B it was 2.9 and 2.1 respectively. Time taken to get back to activity was significantly more in conventional stripping compared to invagination stripping (p<0.001).

Conclusions: From this study we concluded that Invagination stripping is a suitable alternative to time honoured conventional varicose vein stripping with added advantage of less blood loss, less postoperative pain and shorter time span to get back to work.


Invagination, Stripping, Varicose veins

Full Text:



Raffetto J, Eberhardt RT. Chronic venous disorders: General considerations. In: Cronenwett JL, Johnston W, editors. Rutherford‟s Vascular Surgery. 7th ed. Philadelhia, PA: Saunders Elsevier. 2010; 831-40.

Lim CS, Davies AH. Pathogenesis of primary varicose veins. Brit J Surg: Incorporating Euro J Surg Swiss Surg. 2009;96(11):1231-42.

Nigar Z, Alam MA. Effect of taleeq (leech therapy) in dawali (varicose veins). Ancient Sci Life. 2011;30(3):84.

Furtado de Medeiros CA, Luccas GC. Comparison of endovenous treatment with an 810 nm laser versus conventional stripping of the great saphenous vein in patients with primary varicose veins. Dermatol Surg. 2005;31(12):1685-94.

Goren G, Yellin AE. Invaginated axial saphenectomy by a semirigid stripper: perforate-invaginate stripping. J Vascular Surg. 1994;20(6):970-7.

Nisar A, Shabbir J, Tubassam MA, Shah AR, Khawaja N, Kavanagh EG, et al. Local anaesthetic flush reduces postoperative pain and haematoma formation after great saphenous vein stripping—a randomised controlled trial. Euro J Vascular Endovascular Surg. 2006;31(3):325-31.

Lacroix H, Nevelsteen A, Suy R. Invaginating versus classic stripping of the long saphenous vein. A randomized prospective study. Acta Chirurgica Belgica. 1999;99(1):22-5.

Menzoian JO. Presidential address. Lest we forget: the contributions of Andreas Vesalius and Ambroise Paré to my surgical practice. Am J Surg. 1999;178:85-91.

Cassidy L, Bandela S, Wooten C, Jennifer C, Tubbs RS, Loukas M. Friedrich Trendelenburg: Historical backgroundand signifiant medical contributions. Clini Anatomy. 2014;27:815-20.

Lascaratos J, Liapis C, Kouvaraki M. Surgery on varices in Byzantine times (324- 1453 CE). J Vascular Surg. 2001;33:197-203.

Moore W. The operative treatment of varicose veins, with special reference to a modifiation of Trendelenburg’s operation. Intercol Med J Aust. 1896;1:393-7.

Scheltinga MR, Wijburg ER, Keulers BJ, de Kroon KE. Conventional versus invaginated stripping of the great saphenous vein: a randomized, double-blind, controlled clinical trial. World J Surg. 2007;31(11):2236-42.

Butler CM, Scurr JH, Smith PC. Prospective randomised trial comparing conventional (Babcock) stripping with inverting (PIN) stripping of the long saphenous vein. Phlebol. 2002;17(2):59-63.

Durkin MT, Turton EP, Scott DJ, Berridge DC. A prospective randomised trial of PIN versus conventional stripping in varicose vein surgery. Annals Royal Coll Surg Engl. 1999;81(3):171.