ASSESSMENT OF POSTOPERATIVE COMPLICATIONS AND RECURRENCE FOLLOWING DIFFERENT TECHNIQUES OF VARICOSE VEIN SURGERY

Abstract

: Varicose vein disease is one of the most frequently encountered chronic venous disorders worldwide, and surgical treatment remains a primary intervention for symptomatic patients. There are multiple surgical techniques that are regularly used to treat varicose veins, such as high ligation with stripping, foam sclerotherapy, endovenous laser ablation (EVLA), and radiofrequency ablation (RFA). However the postoperative complications and recurrence vary significantly between surgical techniques. Understanding the short-and long-term postoperative complications and recurrence rates is essential for determining a treatment plan, and ultimately improving patient safety and satisfaction.

Aim and Objectives: To compare postoperative complications and recurrence rates using different surgical techniques for the management of varicose vein disease and consider post-operative recovery and patient satisfaction using different techniques.

Materials and Methods: A prospective, comparative observational study was designed to compare the outcomes of patients undergoing surgery for varicose vein disease at a tertiary care hospital over a 12-month time period. There were a total of 60 patients identified with clinical diagnosis of primary varicose veins (CEAP C2-C5) that were randomized into 3 separate groups based on the surgical technique performed. Group A underwent high ligation with stripping; group B had undergone endovenous laser ablation (EVLA); group C had undergone radiofrequency ablation (RFA). The following standardized preoperative assessment, intraoperative technique, and postoperative care were ensured. The following outcome parameters were registered: postoperative pain, hematoma, ecchymosis, wound infection, nerve injury, deep vein thrombosis, and early recurrence in the vein. Patient follow-up included the 1-week, 1 month, and 3-month postoperative assessment. The data was then statistically analyzed and p < 0.05 determined as statistically significant.

Results: The baseline demographic and clinical profile was similar across all three groups. Postoperative pain scores were significantly lower for the minimally invasive techniques (EVLA and RFA) compared to stripping, as well as less hematoma and ecchymosis. The stripping cohort experienced a higher rate of wound complications while nerve-related symptoms were more common in the EVLA cohort. The RFA cohort had the lowest rate of early recurrences, followed by EVLA, and the stripping cohort had the most early recurrences. The RFA cohort also had the highest scores for satisfaction and return to normal activity. No major complications (deep vein thrombosis and pulmonary embolism) occurred in any of the cohorts.

Conclusion: All surgical approaches to varicose veins were effective; however, the minimally invasive approaches (EVLA and RFA) had fewer complications and quicker times to return to activities of daily living. RFA had the fewest recurrences and best satisfaction scores, while stripping had more complications and recurrences. The appropriate technique choice should be made based on the severity of disease, availability of techniques, and postoperative outcomes desired by the patient.