A comparative study on outcome of surgical management of varicose veins with and without venous stripping

INTRODUCTION: Varicose veins are one of the oldest known diseases of mankind, since the beginning of written history. Varicose veins are dilated, elongated and tortuous veins. It is a progressive disease which worsens as day passes. Though not a very fatal disease the morbidity caused by this disease is more. The treatment modalities available are conservative, surgical and endovenous therapies. The treatment option should be individualized based on their general condition and symptomatology of the patient. In this comparative study the outcome of surgical management of varicose veins with and without venous stripping is compared and analyzed. OBJECTIVES: The main objective of this comparative study is to compare the outcome of two surgical treatment modalities of varicose veins. One group of patients undergoes Trendelenburg procedure with Subfascial ligation of incompetent perforators whereas the other group undergoes Trendelenburg procedure with Subfascial ligation of incompetent perforators with stripping of long saphenous vein from groin to knee. The two modalities are compared in terms of 1. Hematoma formation in the thigh. 2. Healing of wounds in the leg at the site of incompetent perforators. 3. Comfortable ambulation without much pain on first post-operative day. 4. Postoperative hospital stay. 5. Pain relief of the patient after two months. MATERIALS AND METHODS: During the period of September 2011 to November 2012, 92 cases of varicose veins were operated in all surgical units in Coimbatore Medical College Hospital, Coimbatore. For this study 50 cases in the age group of 16 to 70 were taken. STUDY DESIGN: Comparative study. INCLUSION CRITERIA: 1. Varicose vein with saphenofemoral valve incompetence and perforators incompetence. 2. Age between 16 and 70. EXCLUSION CRITERIA: 1. Age extremes 70. 2. Patients with deep vein thrombosis. 3. With associated short saphenous vein varicosity. 4. With venous ulcer or other skin changes 5. Recurrent varicosity. For all the patients, detailed history, clinical examination, basic blood investigations, chest x-ray, ECG, venous Doppler of the affected limb were taken. CONCLUSION: In this comparative study which was done in 50 patients, the observations of short term variables show that the venous stripping has increased incidence of hematoma formation and the ambulation of patients on first post operative day was very painful. With reference to wound healing, hospital stay and pain relief there is no significant difference between the two procedures. So, as for as the variables observed, the Trendelenburg procedure with incompetent perforators ligation without venous stripping appears to be better than Trendelenburg procedure with incompetent perforators ligation with venous stripping.