ENDOSCOPIC VERSUS OPEN SUBFASCIAL DIVISION OF INCOMPETENT PERFORATING VEINS IN THE TREATMENT OF CHRONIC VENOUS INSUFFICIENCY

Purpose: Subfascial division of incompetent perforating veins plays an important role in the surgical treatment of 
patients with chronic venous insufficiency of the lower leg. To minimize the high incidence of postoperative wound 
complications after open exploration, endoscopic approaches have recently been developed. This study compares between open and endoscopic treatment of these patients concerning ulcer healing and postoperative wound complications. 
Methods: Patients with current venous ulceration on the medial side of the lower leg were allocated to open exploration 
by the modified Linton approach (Group I) or endoscopic exploration by use of a laparoscope (GroupII). 
Results: Fifty patients were allocated for this study. The incidence of wound infections after open exploration was 53%, 
compared with 0% in the endoscopic group (P< 0.001). Patients in the open group needed longer hospital stays (mean=8 days; range= 3 to 42 days) than patients in the endoscopic group (mean= 3 days; range= 1 to 6 days; P= 0.001). After the operation the ulcers of 84% of patients in the open group and 88% in the endoscopic group had healed. The patients were followed (6 to 24 months), recurrences had occurred in two patients in group I & one patient in group II. 
Conclusions: Endoscopic division of incompetent perforating veins is equally as effective as open surgical exploration 
for the treatment of venous ulceration of the lower leg but leads to significantly fewer wound healing complications. 
Endoscopic division of the perforators is there fore the preferred method.