Online ISSN: 2515-8260

Keywords : Edema

Efficacy of Sub Fascial Endoscopic Perforator Surgery (SEPS) in the Treatment of Lower Limb Varicosities with Perforator Incompetence

N.Ashok Vardhan Kumar, Hareesha Jaggari,J. Parthasarathi, Md Shadab Jaseem

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2443-2450

Background:To study the efficacy of sub fascial endoscopic perforator surgery (SEPS) in the treatment of lower limb varicosities with perforator incompetence.
Materials and Methods: The present study is A Prospective Comparitive Study Between SepsAnd Open Perforator Ligation To Know The Efficacy Of Seps In Treating Varicose Veins done at Kamineni institute of medical sciences,Narketpally from October 2017-september 2019. 50 cases of varicose veins with perforator incompetence were studied,the statistical data and analysis of the cases studied during this period are presented in the study.
Results: In the present study, One thirds (16/50 i.e 32%) of the patients in our study were in the age group of >60 years. The ratio of male to female was 2.33:1. In our study 36%(i.e.18 patients) had involvement of left lower limb out of which 9 patients underwent SEPS and 9 underwent open ligation. Right lower limb involvement was seen in 42%(i.e.21 patients) out of which 15 underwent SEPS and 6 underwent Open ligation. Both limbs involvement was seen in 22%(i.e.11 patients) out of which 1 underwent SEPS and 10 underwent OPEN LIGATION. In our study 100% of the patients had dilated veins and discomfort as presenting symptoms. Itching was present in 88% of patients; skin pigmentation in 46%; edema 82% and ulceration in 14% of patients. 7 patients (14%) amongst the 50 patients had an active ulcer at the time of presentation. All were having single ulcers, most of them(4/7) less than <1 yr duration. 4 among 7 patients with venous ulcer underwent seps,3 underwent open ligation. In SEPS group, 3 perforators were ligated in 10 out of 25 patients and more than 3(4-5) perforators were ligated in 15 out of 25 patients. In open perforator ligation group, 3 perforators were ligated in 17 out of 25 patients and more than 3(4-5) perforators were ligated in 8 out of 25 patients. In our study no post, operative complications were observed in the seps group but in open perforator ligation group 2 patients developed complications like haematoma, wound infection and wound dehiscence. Post operativepersistance of dilated veins and discomfort was noted only in one patient out of 50 and belonged to open ligation group. The ulcer healed in all the 4 patients who underwent SEPS, but in open ligation group out of 3 patients ulcer healed only in 2 patients and persisted in one. In SEPS group, edema subsided in 11 out of 25 patients but persisted in 14, while in OPEN perforator ligation group edema subsided in only 2 out of 25 patients and persisted in 23 patients. Post operative stay-Among 25 patients who underwent SEPS 24 patients stayed for <10 days, whereas in open ligation group all the 25 patients stayed for > 10 days and 3 of them stayed for >20 days.
Conclusion: SEPS should be an added procedure along with conventional varicose veins surgery in order to reduce long term recurrences of the venous ulcer and promote wound healing. Hence with the favourable and significant ulcer healing rate with improvement and  reduction in clinical severity suggests that SEPS plays an important role in surgical   management of advanced stages of venous insufficiency.