DOI: http://dx.doi.org/10.18203/2349-2902.isj20203529

Outcomes of subfascial endoscopic perforator ligation surgery versus open subfascial ligation surgery of incompetent perforator veins in the treatment of varicose veins

Bathala Udayee Teja, Bommareddy Akhila, Mahesh V., Ramesh Reddy, Bhanoo Tej Bathala, Rav Tej Bathala

Abstract


Background: Varicose veins are common and are present in at least 10% of the general population. There are several techniques available in surgeon’s armamentarium for varicose veins treatment such as, ultrasound guided foam sclerotherapy, endovenous laser ablation, radiofrequency ablation, open perforator ligation, endoscopic perforator ligation.

Methods: It was prospective randomized study. Test group underwent subfascial endoscopic perforator surgery (SEPS) by the two-port method. Control group underwent open subfascial ligation of perforators.

Results: Study included 25 patients in each group. Perforator incompetence was seen in bilateral limbs in 8% in both the groups. Post op stay in open group is 7.3±0.6 days and 5.2±0.9 days in SEPS group. Post-operative day 7 VAS scoring was 1.0±0.4 in open group and 0.4±0.5 in SEPS group which is statistically significant. Post operatively wound site hematoma was seen in 9 patients in open group on post-operative day 1, which disappeared in 8 patients by day 5 and in 1 patient evacuation was done and 3 patients developed wound site hematoma in SEPS group, which resolved by day 5. Ulcer recurrence was not seen in both groups at 1 year follow up.

Conclusions: This study shows the superiority of SEPS over open technique because of shorter hospital stay, lesser post-operative complications like pain, hematoma formation, wound infection, total number of perforators ligated, early recovery. Though longer follow up is needed to comment about the true superiority of SEPS versus open subfascial ligation of perforators in treatment of varicose veins.


Keywords


SEPS, Varicose veins, Perforator ligation, Sub-fascial endoscopic surgery

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References


Burkitt DP. Varicose veins, deep vein thrombosis, and haemorrhoids: Epidemiology and suggested aetiology. Br Med J. 1972;2:556.

Labropoulos NSS, Kang MA, Mansour AD, Giannoukas J, Buckman W, Baker H. Primary superficial vein reflux with competent saphenous trunk. Eur J Vasc Endovasc Surg. 1999;18(3):201-6.

Brand FN, Dannenberg AL, Abbott RD. The epidemiology of varicose veins: The Framingham study. Am J Prev Med. 1988;4:96.

Pierik EGJM, Urk MDHV. Endoscopic versus open subfascial division of incompetent perforating veins in the treatment of venous leg ulceration: A randomized trial. J Vasc Surg. 1997;26(6):1049-54.

Blomgren L, Johansson G, Emanuelsson L. Late follow up of a randomised trial of routine duplex imaging before varicose vein surgery. J Vascular Surg. 2012;55(2):615.

Jugenheimer M, Junginger T. Endoscopic subfascial sectioning of incompetent perforating veins in treatment of primary varicose veins. World J Surg. 1992;16:971-5.

Kulbaski MJ. Subfascial Endoscopic Perforator Surgery: New Life for an Old Procedure. JSLS. 1997;1(2):135-9.

Nelzen O. Prospective study of safety, patient satisfaction and leg ulcer healing following saphenous and subfascial endoscopic perforator surgery. Br J Surg. 2002;87(1):86-91.

Luebke T, Brunkwall J. Meta-analysis of subfascial endoscopic perforator vein surgery (SEPS) for chronic venous insufficiency. Phlebology. 2009;24(1):8-16.

Kurdal AT, Cerrahoglu M, Iskesen I, Eserdag M, Sirin H. Subfascial endoscopic perforator surgery ameliorates the symptoms of chronic venous ulcer (C6) patients. Int Angiol. 2010;29(1):70-4.

Gloviczki P. Safety, feasibility, and early efficacy of subfascial endoscopic perforator surgery: a preliminary report from the North American registry. J Vasc Surg. 1997;25(1):94-105.

Baron HC, Wayne MG, Santiago CA, Grossi R. Endoscopic subfascial perforator vein surgery for patients with severe, chronic venous insufficiency. Vasc Endovasc Surg. 2004;38(5):439-42.

Sybrandy JE, Gent VWB, Pierik EG, Wittens CH. Endoscopic versus open subfascial division of incompetent perforating veins in the treatment of venous leg ulceration: long-term follow-up. J Vasc Surg. 2001;33(5):1028-32.