Modification of varicose vein stripping to achieve immediate compression in a theatre setting with minimum personnel

Compression bandaging is a key aspect following stripping for varicose vein surgery. With adequate compression, formation of subcutaneous hematoma can be prevented and thereby prevent revascularisation of the hematoma leading to recurrence of varicose vein. Various techniques exist to provide compression. Our modification provides an easy alternative to achieve immediate compression following stripping and is especially useful in a setting where staff is very limited. Materials required include a 10 cm width gauze bandage, 1% lidocaine with epinephrine, and number 1 silk suture in addition to the conventional tools for open varicose vein surgery. The gauze bandage is introduced along with the stripper which is passed from groin to below knee. The bandage is kept in the subcutaneous tunnel till perforator ligation, groin wound closure and application of compression bandage. The gauze bandage is removed through a small window within the compression stocking below the knee and the wound closed in a single layer. From 2005 to 2020, 410 patients underwent varicose vein surgery with the modified technique. Of these, 1 patient developed complication secondary to hematoma formation which was managed conservatively. Our modification of the varicose vein stripping technique is shown to be a cost effective and simple technique which provides immediate compression and effortlessly facilitates haemostasis till wounds are closed and compression stockings applied. in various literatures.

A Novel Comparative Study of Phlebectomy with Invagination Stripping of the GSV Done Under Tumescent and Spinal Anaesthesia: A Prospective Cohort From Tertiary Centre In South India

Background: Varicose veins are commonly encountered vascular disease with wide variety of surgical and minimally invasive /interventional modes of treatment .we put forth a novel economical and efficient technique of performing high ligation, long saphenous vein stripping and Muller's hook phlebectomy in tumescent local anaesthesia compared with spinal anaesthesia. AIM &OBJECTIVE: The purpose of the study was to compare a novel technique of performing phlebectomy and invagination stripping of the GSV using tumescent anesthesia and spinal anesthesia in terms of post operative pain, complications. Methods: A total of 200 patients (100 patients in each arm of spinal anaesthesia group, and tumescent anaesthesia group) diagnosed cases of varicose vein lower limb being operated with phlebectomy and invagination stripping of the GSV at Surgery Department of Government Medical College and Hospital, Kozhikode, Kerala were considered in this study. Consecutive sampling was done. Results: Of these patients, 120 (60%) were female and 40 were male (40%) with a mean age of 35.4 ± 8 and 47.4 ± 14 years, respectively No statistically significant difference with respect to the wound infection, local discomfort, postoperative recurrence rates of varicosity and patients satisfaction score was observed (P > 0.05. Conclusion: Tumescent local anesthesia is a novel, economical and efficient technique of performing high ligation, long saphenous vein stripping and Muller's hook phlebectomy when compared to doing under spinal anaesthesia with similar results.