A Comparative Study on Complications of Surgical Management of Varicose Veins with and Without Great Saphenous Vein STRIPPING

Background: Varicose veins are common peripheral vascular disorder. Multiple methods of management are available, however Trendelenburg Procedure remains the most preferred. Whether stripping of Long Saphenous Vein is beneficial or just adds to the morbidity to the procedure remains controversial. This study compares the outcomes of surgical management of varicose veins with and without venous stripping.

Aims and objectives : The primary objective of this study is to compare the outcome of two surgical treatment modalities of varicose veins. One group undergoes the Trendelenburg procedure with subfascial ligation of incompetent perforators, while the other group undergoes the same procedure, but with the addition of long saphenous vein stripping from the groin to the knee. The two modalities are compared in terms of

1. Contusion formation in the thigh.

2. Comfortable ambulation without much pain on first post-operative day.

3. Postoperative hospital stay.

4.Recurrence after 6 months.

Methodology: 66 cases were allocated into 2 groups, by systematic allocation,  GROUP A ( Trendelenburg procedure with venous stripping with perforator ligation ) had 33 patients and GROUP B (Trendelenburg procedure without venous stripping with perforator ligation) had 33 patients. The two procedures were compared in terms of complications like contusion formation, healing of wounds in the leg at the site of incompetent perforators, comfortable ambulation without much pain assessed by Visual Analog Scale on first post-operative day, duration of hospital stay and recurrence. Patients were followed up regularly for a maximum period of 18 months.

Results : Males constitute majority in both groups. 78.8% population reported prolonged standing in group A and 60.6% in group B, with the highest incidence of disease found in daily wage workers, cooks and bakers. Both the groups were comparable in terms of clinical presentation, past medical history, family history, personal habits, age, and doppler findings.

Group A had a higher percentage of short term complications, including infections (3.0%), paraesthesia (3.0%), and early surgical site infection (3.0%), while Group B had fewer complications. Duration of hospital stay was extended in Group A. There was a statistically significant difference noted in the duration of hospital stay with 30.3% of the patients requiring an extended stay until post-op day 3 in Group A. Group B had a slightly higher recurrence rate (12.1%) compared to Group A (6.1%) after a 6 month follow up period.

Conclusions:  On comparison of outcomes of surgical management of varicose veins with and without venous stripping, Venous stripping is associated with a higher short term complications including pain, contusion, paraesthesia, infection, and extended hospital stay, however it comes with advantage of lesser rate of long term complications including recurrence. We also found the use of Trendelenburg operation with GSV stripping with Perforator ligation is a technically sound option than Trendelenburg procedure with Perforator ligation alone in case of varicose veins with Grade 3, 4 SFJ incompetence.