SUPERIOR RESULTS OF ENDOSCOPIC VERSUS OPEN SUBFASCIAL DIVISION OF INCOMPETENT PERFORATING VEINS IN THE TREATMENT OF VENOUS LEG ULCERATION

E.G.Jm. Pierik, Y. Van Urk, W.C.J. Hop, C.H.A. Wittens
Department of Surgery, Saint Franciscus Hospital,
Department of Surgery, Vascular Unit, University Hospital Rotterdam-Dijkygt,
Department ofBiostatistics, Erasmus University,
Rotterdam, Netherlands

Subfascial division of incompetent perforating veins plays an important role in the surgical treatment of patients with venous ulceration of the leg. To minimise the high incidence of postoperative wound complications with open exploration, recently endoscopic approaches have been developed. We carried out a prospective, ran domised comparison of "open "and "endoscopic "treat ment of these patients aimed at ulcer healing and post operative wound complications. Patients with current venous ulceration on the medial side of the were randomly allocated to open exploration by the modified Linton approach or endoscopic exploration by use of a mediastinoscope. 39 patients were randomised, 19 to the open and 20 to the endoscopic exploration. The incidence of wound infections after open exploration was 53%, compared with 0% in the endoscopic group (p<0.001). The open group needed longer hospital stays (mean 7 (range 3-39) versus 4 (2-6) days (p=0.001). Four months after operation the ulcers of 17 patients (90%) in the open and 17 patients (85%) in the endoscopic group had healed. During a mean follow-up of 21 (range: 16-29) months no recurrences were noticed in either group. Endoscopic division of incompetent perforating veins is equally effective as is open surgical exploration for the treatment of venous ulceration of the leg, but leads to significantly less wound healing complications. Endoscopic division is therefore the preferred method.

P. 20-30

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