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Subfascial endoscopic perforator surgery: new life for an old procedure?

Kulbaski MJ, Eaves FF, Ofenloch JC, Lumsden AB - JSLS (1997 Apr-Jun)

Bottom Line: There were no thromboembolic complications.One procedure was technically unsuccessful because of morbid obesity.SEPS is a safe, minimally invasive procedure which should become an important part of the surgical armamentarium in treating patients with venous ulcers.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Veteran Affairs Medical Center, Decatur, GA, USA.

ABSTRACT

Background: Division of incompetent perforating veins has long been regarded as an appropriate approach for treatment of venous stasis ulcers. The development of endoscopic techniques using standard laparoscopic instrumentation has permitted the application of this therapy without the need for long open incisions, fraught with complications.

Methods: We report our experience with 20 cases of subfascial endoscopic perforator surgery (SEPS) in 19 patients. Seventeen limbs had active ulceration at the time of operation. A gas insufflation technique with two 10 mm ports was used in most cases.

Results: An average of four perforating veins were divided in each case. Mean operating time was 1.5 hours. At a mean follow-up of eight months, initial complete healing occurred in 14 of 17 ulcers, three ulcers improved, and three healed ulcers at the time of SEPS have remained healed. One patient developed a small area of recurrent ulceration after initial healing. There were no thromboembolic complications. One procedure was technically unsuccessful because of morbid obesity. One patient developed a wound infection, and one patient required re-exploration for a subfascial hematoma.

Conclusion: SEPS is a safe, minimally invasive procedure which should become an important part of the surgical armamentarium in treating patients with venous ulcers.

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Related in: MedlinePlus

Ascending venogram, demonstrating filling of the greater saphenous vein (larger arrow) via incompetent perforating veins (small arrows).
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Figure 1: Ascending venogram, demonstrating filling of the greater saphenous vein (larger arrow) via incompetent perforating veins (small arrows).

Mentions: Patients were selected for this procedure because of their history of chronic venous insufficiency. Their basic demo-graphics are described in (Table 1). Operations were performed on 20 limbs in 19 patients. Seventeen patients had an active ulcer, which had been refractory to conventional therapy attempts such as compression and superficial stripping alone. Relevant previous medical history is given in (Table 2). Three patients had recently healed ulcers, but had been treated for periods in excess of four months. Thirteen patients were evaluated using ascending and descending venography (Figure 1). Fifteen patients had color flow duplex scanning performed. There was reflux alone identified in the superficial and deep system in four patients, while 15 patients had a combination of reflux and deep venous obstruction.


Subfascial endoscopic perforator surgery: new life for an old procedure?

Kulbaski MJ, Eaves FF, Ofenloch JC, Lumsden AB - JSLS (1997 Apr-Jun)

Ascending venogram, demonstrating filling of the greater saphenous vein (larger arrow) via incompetent perforating veins (small arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3021261&req=5

Figure 1: Ascending venogram, demonstrating filling of the greater saphenous vein (larger arrow) via incompetent perforating veins (small arrows).
Mentions: Patients were selected for this procedure because of their history of chronic venous insufficiency. Their basic demo-graphics are described in (Table 1). Operations were performed on 20 limbs in 19 patients. Seventeen patients had an active ulcer, which had been refractory to conventional therapy attempts such as compression and superficial stripping alone. Relevant previous medical history is given in (Table 2). Three patients had recently healed ulcers, but had been treated for periods in excess of four months. Thirteen patients were evaluated using ascending and descending venography (Figure 1). Fifteen patients had color flow duplex scanning performed. There was reflux alone identified in the superficial and deep system in four patients, while 15 patients had a combination of reflux and deep venous obstruction.

Bottom Line: There were no thromboembolic complications.One procedure was technically unsuccessful because of morbid obesity.SEPS is a safe, minimally invasive procedure which should become an important part of the surgical armamentarium in treating patients with venous ulcers.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Veteran Affairs Medical Center, Decatur, GA, USA.

ABSTRACT

Background: Division of incompetent perforating veins has long been regarded as an appropriate approach for treatment of venous stasis ulcers. The development of endoscopic techniques using standard laparoscopic instrumentation has permitted the application of this therapy without the need for long open incisions, fraught with complications.

Methods: We report our experience with 20 cases of subfascial endoscopic perforator surgery (SEPS) in 19 patients. Seventeen limbs had active ulceration at the time of operation. A gas insufflation technique with two 10 mm ports was used in most cases.

Results: An average of four perforating veins were divided in each case. Mean operating time was 1.5 hours. At a mean follow-up of eight months, initial complete healing occurred in 14 of 17 ulcers, three ulcers improved, and three healed ulcers at the time of SEPS have remained healed. One patient developed a small area of recurrent ulceration after initial healing. There were no thromboembolic complications. One procedure was technically unsuccessful because of morbid obesity. One patient developed a wound infection, and one patient required re-exploration for a subfascial hematoma.

Conclusion: SEPS is a safe, minimally invasive procedure which should become an important part of the surgical armamentarium in treating patients with venous ulcers.

Show MeSH
Related in: MedlinePlus