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Comparing Outcomes of Endoscopic Versus Duplex-Guided Open Subfascial Interruption of Incompetent Perforators in Management of Varicose Veins: A Randomized Control Trial

Abhishek Verma* , Abhishek Verma* , Jitendra Kumar Kushwaha** , Awanish Kumar** , Akshay Anand*** , Abhinav Arun Sonkar**** , Harvinder Singh Pahwa*****

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New Indian Journal of Surgery 7(3):p 261-267, Sept - Dec 2016. | DOI: DOI: https://dx.doi.org/10.21088/nijs.0976.4747.7316.8

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Abstract

 Introduction:This randomized controlled study was conducted to compare outcomes of both subfascial endoscopic perforators surgery (SEPS) by using conventional laparoscopic instruments and duplexguided open subfascial interruption of perforators. Methods: Patients with clinical lower limb varicosities were allocated randomly to open subfascial interruption of perforator or SEPS. After completion of SEPS if patients had incompetent SFJ, flush ligation and stripping of GSV from SFJ to level of the first port was done concurrently (Trendelenberg’s procedure). Results: Eighteen patients were allocated to SEPS and 17 to the open surgery group. Two patients in the SEPS group were excluded (lost to follow up).Mean operative time (statistically insignificant) and mean number of perforators (statistically significant) were slightly higher in SEPS. Wound complications and mean hospital stay time wassignificantly reduced in SEPS. SEPS also resulted in faster ulcer healing with zero event rates of paresthesia, DVT and recurrence. Conclusion: SEPS warrants an early return to home and minimizes wound complications. DVT and recurrence were not noted in SEPS group. SEPS is easy, safe and feasible by conventional laparoscopic instruments.It is an attractive option of treatment for incompetent perforators in a developing country where endovenous ablation facilities are not widely available.

Keywords: Subfascial Endoscopic Perforator Surgery; Open Perforator Ligation; Varicose Veins; Perforator Incompetence.

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DOI: DOI: https://dx.doi.org/10.21088/nijs.0976.4747.7316.8

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