Subfascial endoscopic perforator surgical ligation [SEPS]: single versus double port

ABSTRACT

SEPS is on the rise in treating chronic venous insufficiency. Limitations of the two entry ports technique, to find the incompetent perforators and interrupt them, are due to the narrow subfascial space. The situation is made more difficult whenever dense overlying liposclerotic skin does not allow enough distensibility to create a subrfacial plane sufficient for viewing and manipulating the perforator veins via the two ports. Single port double channel laparoscopes were meant to overcome those difficulties. Was to compare the difference in technicality, and results between the single and double port scope, on performing SEPS. All cases were C 6 [open ulcer] according to CEAP classification. They were divided into two groups; fifty patients underwent SEPS using double port, and fifty Patients underwent SEPS using single port. Both groups were matched for age, sex, risk factors, medial and lateral distribution of the ulcer, and size. The first group that underwent SEPS using single port had the upper hand in reducing the operative time, ease of maneuverability within the leg compartment, ease of accessibility of the posterior compartment from a medial or lateral entry approach. Regarding the intra-operative findings in comparison to pre-operative duplex findings as regards perforators, results were more satisfactory in the first group. Hematoma, wound infection, and neuralgia of saphenous and sural nerves were not different lwith the single port SEPS, however, small patches of superficial skin gangrene over areas of extensive septum dissection to reach perforators lying, within it was observed in some diabetic cases. The progressive ulcer healing following primary SEPS was -96% using the single port in comparison to 84% for the doble port [statistically significant]. Repeat SEPS for ligation of the missed perforators was feasible and much easier using the single port. The advantage of the single port due to its better maneuverability leading to significantly shorter operative time and better accessibility to posterior compartment perforators after piercing of the intramuscular septum, and higher venous ulcer healing rate can be clearly shown