RESUMEN
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.
RESUMEN
Background: Venous disorders are very common. About 20% of the population suffer from varicose veins, 2% have skin changes which may precede venous ulceration1. Venous ulcers represent a common and debilitating condition associated with significant financial loss for the patients as well as the society. Treatment options for these patients are costly and time consuming. In this study we tried to find out cost -effective measures for treating this group of patients. Method: To evaluate the effectiveness and safety of superficial and perforating leg venous surgery along with pharmacotherapy 66 patients with chronic venous leg ulcers are prospectively studied. After proper history taking and clinical examination all patients underwent venous duplex ultrasonography. Patients were divided into two groups. Group I (n=30) includes patients undergoing saphenofemoral ligation and stripping of the great saphenous vein (GSV). In group II (n=36) patients underwent saphenofemoral and incompetent leg perforator ligation along with stripping of the GSV. Conservative measures, local ulcer care and pharmacotherapy were common in both groups. Result: Postoperative complications, total hospital stay and ulcer healing were studied. Ulcer healing was earlier in group II. Remarkable complications were similar in both the groups. Conclusion: For effective and economic care of venous leg ulcers, combination of standard surgical procedures including incompetent perforator and saphenofemoral ligation with great saphenous vein stripping and standard physio-pharmacotherapeutic care is essential. This combined modality of treatment is highly effective in early and complete ulcer healing in patients suffering from venous ulcers.