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This describes high saphenous ligation and stripping of the long saphenous vein together with multiple avulsions.

Preoperative Preparation

Doppler studies are used to display valvular and perforator incompetence. Mark the varicosities with indelible pen.

 

 

Anaesthesia

General or spinal.

Position

Supine withTredelenburg tilt

Incision

First, a transverse groin crease over the sapheno-femoral junction.

 

Procedure

Ligate and divide all of these branches while approaching the sapheno-femoral junction.

• After clearly identifying the junction, divide and perform a flush ligation of the long saphenous vein.
• If stripping is indicated, place a ligature around the long saphenous trunk and make a small venotomy below it to pass the vein stripper (flexible steel or disposable plastic).
• Gently manipulate the tip of the stripper through the lumen of the long saphous vein down to the level of knee joint.
• Make a stab incision over the palpable tip of the stripper and deliver it onto the surface.
• Strip the long saphenous vein from the groin to the knee with steady downward traction.

• After completion, multiple avulsions are performed of leg varicosities – separate stab incisions are made near the varicosities and avulsions are performed by traction and dissection.

 

• The short saphenous at the back of the popliteal fossa may also need ligation.

Closure

The groin incision can be closed with subcuticular suture and paper tapes to the stab incisions.

Postoperative Management

A compression bandage is applied to the leg for one week and early mobilisation.