A Clinical Study on Technique of Subfascial Endoscopic Perforators Surgery: A Recent Advancement

Abstract

Introduction: Varicose veins are a punishment to the human beings. It usually occurs in a people who work in prolonged
standing posture. Varicose veins associated with perforator incompetency may lead to chronic venous insuffi ciency. Chronic
venous insuffi ciency is the predisposing factor in the development of venous ulcers. Division of incompetent perforators has
long been regarded as an appropriate approach for the treatment of venous stasis ulcers. In conventional open techniques, long
incisions are required to approach and to divide the incompetent perforators. Subfascial endoscopic perforator surgery (SEPS)
is a minimal invasive procedure, which is more comfortable and benefi ciary to the patient. The development of endoscopic
techniques using standard laparoscopic instrumentation has permitted the application of this therapy without the need for
long open incisions and complications. Division of below knee incompetent perforators is possible with very small incisions in
SEPS technique. In view of minimal invasive nature, less morbidity, cosmetic reasons, less recurrence rate and less duration
of hospital stay, this advanced technique have to be practiced.
Materials and Methods: Surgeries conducted on 15 patients with incompetent below knee perforators. The technique of
procedure is SEPS. One and laparoscope, two 10 mm ports are used.
Results: Average of four incompetent perforators are divided in each limb, mean operative time is 1 h. Duration of hospital stay
1.5 days, no thromboembolic complications, all ulcers healed by 6 months, No further bleeding and hyperkeratotic changes in
post-operative follow-up periods.
Conclusion: SEPS is a safe, minimally invasive procedure, cosmetic and cost-effective, requires less hospital stay, no need
of suture removal, less complications, less recurrence rate and more advantage to the patients than other conventional open
techniques.