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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

After creating the optical cavity, a larger perforating vein bridging from the underlying gastrocnemius muscle (arrow) to the fascia above has been clipped and is about to be divided.
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Figure 3: After creating the optical cavity, a larger perforating vein bridging from the underlying gastrocnemius muscle (arrow) to the fascia above has been clipped and is about to be divided.

Mentions: Endoscissors are inserted through the second port and the subfascial space is easily opened by sharp dissection of all the bridging fascial bands. Large perforating veins can be readily identified, clipped and divided (Figure 3) within the superficial posterior compartment. Dividing the perforating veins further opens the space, permitting more distal visualization and dissection.


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

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

After creating the optical cavity, a larger perforating vein bridging from the underlying gastrocnemius muscle (arrow) to the fascia above has been clipped and is about to be divided.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: After creating the optical cavity, a larger perforating vein bridging from the underlying gastrocnemius muscle (arrow) to the fascia above has been clipped and is about to be divided.
Mentions: Endoscissors are inserted through the second port and the subfascial space is easily opened by sharp dissection of all the bridging fascial bands. Large perforating veins can be readily identified, clipped and divided (Figure 3) within the superficial posterior compartment. Dividing the perforating veins further opens the space, permitting more distal visualization and dissection.

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