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

  • Siva Rama Krishna Valluru Assistant Professor, Department of Surgery
  • K Babji Professor, Department of Surgery
Keywords: Laparoscopy, Minimally invasive, Subfascial endoscopic perforator surgery, Venous ulcer


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

Author Biographies

Siva Rama Krishna Valluru, Assistant Professor, Department of Surgery

Government General Hospital, Kakinada, Andhra Pradesh, India

K Babji, Professor, Department of Surgery

Government General Hospital, Kakinada, Andhra Pradesh, India


1. Homans J. The etiology and treatment of varicose ulcer of the leg. Surg
Gynecol Obstet 1917;24:300-11.
2. Linton RR. The communicating veins of the lower leg and the operative
technic for their ligation. Ann Surg 1938;107:582-93.
3. Cockett FB. The pathology and treatment of venous ulcers of the leg. Br J
Surg 1955;43:260-78.
4. Dodd H. The diagnosis and ligation of incompetent perforating veins. Ann
R Coll Surg Engl 1964;34:186-96.
5. Hauer G. Endoscopic subfascial discussion of perforating veins –
preliminary report. Vasa 1985;14:59-61.
6. Jugenheimer M, Junginger T. Endoscopic subfascial sectioning of
incompetent perforating veins in treatment of primary varicosis. World J
Surg 1992;16:971-5.
7. Dohi K, Haruta N, Fukuda Y. Operative treatment of varicose veins. Surg
Ther 1995;72:887-9.
8. Cikrit DF, Nichols WK, Silver D. Surgical management of refractory
venous ulceration. J Vasc Surg 1988;2:5-12.
9. Healey PJ, Healey EH, Wong R, Schaberg FJ Jr. Surgical management of
the chronic venous ulcer: the Rob procedure. Am J Surg 1979;137:556-9.
10. De Palma RG. Surgical therapy for venous stasis. Surgery 1974;76:910-7.
11. Sarin S, Scurr JH, Smith PD. Medial calf perforators in venous disease: the
signifi cance of outward fl ow. J Vasc Surg 1992;16:40-6.
12. Gloviczki P, Bergan JJ, Menawat SS, Hobson RW 2nd, Kistner RL,
Lawrence PF, et al. Safety, feasibility, and early effi cacy of subfascial
endoscopic perforator surgery: a preliminary report from the North
American registry. J Vasc Surg 1997;25:94-105.