VARICOSE VEIN SURGERY

A DAY CASE PROCEDURE

Abstract

Objectives: To evaluate the epidemiological aspects and
feasibility of varicose veins surgery as a day case procedure in all patients of primary varicose veins and to
identify the risk factors for hospital admission. Design: Interventional with prospective observational study.
Place & Duration: This study was conducted from Nov 1999 to Oct 2003 at the department of Surgery B V
Hospital Bahawalpur. Patients& Methods: Fifteen patients, 1 female and 15 male of varicose veins attending
the surgical outdoor fulfilling the inclusion criteria and requiring varicose veins surgery underwent their
procedure performed as a day case. A standard technique of sapheno femoral ligation with stripping of the long
saphenous vein to just below knee and multiple stab avulsions of varicosities after subfascial ligation of the
perforators was performed. All cases were reviewed postoperatively for eight weeks. Results: All fifteen patients
underwent varicose vein surgery, of whom 33% had bilateral varicosities and all had primary varicose veins. The
common presentation of all patients (80%) was heaviness, leg fatigue and dull pain in the calves during walking.
Six (40%) patients had hyper-pigmentation with leg edema. 33.3% varicose ulcers and 13.4% bleeding
varicosities with dermatosclerosis or / and eczematoid dermatitis while the remaining 13.4% patients had
asymptomatic varicosities. Three patients (20%) developed postoperative complications. Ten 66.67% patients
were discharged on the day of surgery while remaining 5 patients (33.34%) required admission due to minor
anaesthetic complications and patient’s preference, among whom two (13.4%) required admission for more than
24 hours. The need for over night admission was associated with the age of the patients, bilateral varicose vein
surgery and the use of spinal anaesthesia. Conclusion: Although varicose vein surgery is safe, acceptable and
cost effective as a day case or ambulatory surgical procedure, if attempted in all patients, overnight admission
will be required in a significant proportion. Preoperative selection of the patients is mandatory to achieve
optimal results.