Page 45 - Journal of WALS

Ravikumar S

to 10 days after surgery. Those patients with an active ulcer Without proper detail to all these parameters, it is difficult
need regular further dressings till the ulcer heals. Class II to draw a conclusion. One should always think that SEPS and
graduated compressive stockings are prescribed to all patients open conventional procedure as being complementary to each
in a long-term basis. other.
A successful outcome requires greater skill of the operating
DISCUSSION surgeon adequate training in the field of minimal access surgery.
SEPS requires different skills and technological knowledge. In
SEPS has gained a lot of attention around the world. A lot of fact many studies have shown that the outcome of SEPS was
controlled trails have been conducted; many are in favor of influenced by experience and technique of the operator.
SEPS. The goal of this review was to ascertain that if the SEPS In a study done by Anjay Kumar , 21 patients of varicose
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procedure for perforator incompetence is superior to convention veins with an incompetent perforator underwent SEPS using a
open (Lintons) surgical procedure, and if so what are the benefits harmonic scalpel. Various parameters were studied. The result
and how it could be more widely instituted. There is lot of of their study was that, all ulcers healed in 8 weeks with no
diversity in randomized controlled trails. The main variables in recurrence in 11.9 months follow-up period. There was one case
these trails are: of wound infection and one saphenous nerve neuropraxia as
• Number of patients in trail complications noted postoperatively. They concluded that
• Withdrawal of cases using ultrasonic scalpel in SEPS is technically feasible, causing
• Blinding less tissue damage as the thermal effect it generates is very low,
• Intention to treat analysis and also the study was associated with minimal morbidity.
• Publication biases In another study by T Luebke and J Brunkwall , a meta-
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• Local practice variations analysis of subfascial endoscopic perforator vein surgery (SEPS)
• Prophylaxis antibiotic used for the treatment of chronic venous insufficiency was done.
• Follow-up failure. Here, a multiple health database search was performed,
including Medline, Embase, Ovid, Cochrane Database of
Systematic Reviews and Cochrane Database of Abstracts of
Reviews of Effectiveness, on all studies published between
1985 and 2008, that reported on health outcomes in patients
with CVI treated with SEPS and comparing this therapy with the
conventional Linton procedure. Three studies, which compared
SEPS with conventional surgery, were included in the meta-
analysis. Results of the study was that between SEPS and Linton
groups, there was a significant lower rate of wound infections
in the SEPS group [odds ratio (OR) 0.06 (95% confidence interval
(CI) 0.02 to 0.25)] and a significantly reduced hospital stay for
SEPS [OR: 8.96 (95% CI: 11.62 to – 6.30)]. In addition, there was
a significant reduced rate of recurrent ulcers in SEPS group
(mean follow-up 21 months) [OR 0.15 (95% CI 0.04-0.62)]. There
Fig. 6C: Perforator vein seen after creation of subfascial space was no significant difference between the groups in the

Fig. 6D: Clipping of perforator Fig. 6E: After clipping of perforator

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