EVALUATION OF ‚??SEPS‚?Ě PROCEDURE IN THE MANAGEMENT OF PRIMARY VARICOSE VEINS WITH INCOMPETENT LOWER LIMB PERFORATOR

Abstract

Shaik Ahmad Sheriff1, Penugonda Adeppa2, Basaveswara Gopi Krishna3

BACKGROUND
Varicose veins affect at least 1 out of 5 in the world and the cost of health care for the society is significant. In a developing country like India, study encompassing the clinical evaluation and management of lower limb varicose veins on the conventional lines seems a necessity to improve the quality care with the available resources.
OBJECTIVES
To study the relation between site of incompetence and complications, pattern of complications, surgical management and its outcome for lower limb varicose veins.
METHODS
A total 26 number of patients with primary varicose veins admitted, investigated, operated and followed up. Final outcome evaluated. All the information was taken down in the proforma, designed for the study.
RESULTS
In the study, it was noted that the varicose veins affect younger, adult, and middle age population. (20 to 60 years). Majority of the patients were male (84.60%). Perforator incompetence only = 42.3% (n=11). Perforator incompetence + saphenofemoral/saphenopopliteal incompetence seen in 57.7%. Long saphenous vein involvement was seen in 90.5% of the patients and both LSV and SSV involvement in 9.5%. A greater portion of the patients had combined valvular incompetence (69.56%). The mean ulcer healing time in our study was 2.8 weeks following surgery (90%). Residual incompetent perforators are seen in 7.6% (n=2). New incompetent perforators seen in 7.6% (n=2). Postoperative wound infection of the incision of SPJ ligation was seen in 3.8% (n=1) of the patients, but not the SEPS wound infection and the total complication rate was 3.85%. The mean postoperative stay for patients undergoing SEPS procedure alone was 3.6 days. The mean postoperative stay for patients who underwent perforator ligation with concomitant stripping procedure was 5 days.
INTERPRETATION AND CONCLUSION
Majority of the patients present with complications of varicose vein with combined valvular incompetence and surgical treatment with stripping of path of incompetence (i.e. LSV trunk) appear to be best option for lower limb varicose vein with LSV truncal involvement under our settings. SEPS is a new, low risk, less postoperative stay, procedure that effectively decreases perforator reflux in patients with venous ulcerations, and should be added to our armamentarium to treat patients with advanced chronic venous disease.

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