Laparoscopic Varicose Vein Surgery in India

What are varicose veins ?

The word “varicose” comes from the Latin root “varix,” which means “twisted.” Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That’s because standing and walking upright increases the pressure in the veins in your lower body.

The veins of the legs are divided into two systems – the deep veins (which run deep to the leathery layer of fascia surrounding the muscles) and the superficial veins (which run in the layer of fat just beneath the skin). The superficial veins are the ones that you can see (for example, on your foot or around the ankle) and they are the ones that can become varicose. It is essential to keep in mind these two different systems – deep and superficial – in order to understand varicose veins and their treatment. In a number of places in the leg, the superficial and deep veins are linked by perforating veins (or ‘perforators’). They are called perforators because they perforate the leathery fascial layer surrounding the muscles of the legs. Normally their valves should allow blood to flow only inwards – from the superficial veins to the deep veins. If the valves stop working properly, then blood is pushed out into the superficial veins when the muscles contract: this is one reason for high pressure in the superficial veins, and can be a cause of varicose veins.

The blood in your leg veins must work against gravity to return to your heart. To help move blood back to your heart, your leg muscles squeeze the deep veins of your legs and feet. One-way flaps called valves in your veins keep blood flowing in the right direction. When your leg muscles contract, the valves inside your veins open. When your legs relax, the valves close. This prevents blood from flowing backward. However, when these valves do not function properly, the blood pools, pressure builds up, and the veins become weakened, enlarged, and twisted. This causes varicose veins to develop. Varicose veins develop when one has faulty valves in the veins and weakened vein walls. These veins are twisted, enlarged veins close to the surface of the skin. They usually develop in the legs and ankles.

Varicose veins are a common condition, affecting up to 15 percent of men and up to 25 percent of women. Treatment may involve self-help measures or procedures by your doctor to close or remove veins.

What causes of varicose vein ?

Some people may be more likely than others to develop varicose veins and spider veins because of inherited characteristics (genetics), the aging process, or hormone changes. Varicose veins may also result from conditions that increase pressure on the leg veins, for example being overweight or pregnant. Though, the most contributing factor is Hereditary. Women are more likely to suffer from abnormal leg veins. Hormonal factors can affect the disease. It is very common for pregnant women to develop varicose veins during the first trimester. Pregnancy causes increases in hormone levels and blood volume, which in turn cause veins to enlarge. In addition, the enlarged uterus causes increased pressure on the veins. Varicose veins due to pregnancy often improve within 3 months after delivery. However, with successive pregnancies, abnormal veins are more likely to remain. Other predisposing factors include aging, standing occupations, obesity and leg injury. Varicose veins are present in 20-25% of adult females and 10-15% of men. This common condition represents a considerable surgical workload.

Symptoms of varicose vain

In varicose veins, symptoms are often worse at the end of the day because more pooling has occurred. Other things which increase pooling and therefore symptoms also include prolonged standing and sitting, exposure to heat (summertime, hot baths) and hormonal factors (pregnancy, around the time of the menses).

Varicose veins may be associated with a sensation of heaviness and itching and, in the presence of deep and superficial reflux, cramps and aching. However, all too often generalised aches and pains in the leg may be attributed to visible varicosed veins. Ulcers, when they occur, most often afflict the elderly, blighting their lives with frequent visits to their local surgeries or hospital out-patient departments. Many sufferers complain of aching of the legs, skin itching, ankle swelling, restless legs, night cramps and sleep disturbance.

Minimally Access procedures like SEPS

Introduction

A few years ago, long incisions had to be made in the calf to gain access to these difficult veins. The dissection was extensive, the complication rates high and recovery prolonged, which may go a long way to explaining the continued reluctance of many surgeons to treat perforators at all. Perforators can now be treated using a camera. These are exciting refinements that have yielded excellent results in this series. SEPS stands for Subfascial Endoscopic Perforator Surgery. SEPS was introduced more than 15 years ago as a Minimally Acess alternative to open perforator ligature. This is a specialized Minimally Access procedure performed on patients who suffer with leg ulcers due to incompetent perforator veins. Using tiny incisions and an operating scope, perforator veins are tied off. This results in ulcer healing in the vast majority of patients.

Procedure of SEPS

Subfacial Endoscopic Perforator Surgery (SEPS) is a Minimally Access surgical procedure which the doctors use to treat the underlying condition that causes venous ulcers. During the procedure they disconnect the abnormal perforator veins, which cause ulceration because of improperly functioning valves. By disconnecting these veins, they redirect the blood flow to healthy veins. Circulation in the leg is improved, and the ulcer is healed.

SEPS is usually performed with two ports of entry into the leg. A special instrument is inserted deep to the fascia of the leg and a large balloon is inflated with water to create a working space. The balloon is then emptied and the space is insufflated with air. The camera is inserted and the perforator veins can be seen in the space passing from superficial to deep layers. Another small incision is made in the calf for passage of another instrument. The perforator veins are carefully dissected, clips are applied and the veins are divided if necessary. Perforating veins are then divided with endoscopic scissors. Metal clips are placed on the cut ends of the vein to avoid bleeding. Another option to interrupt the vein is to use a harmonic scalpel, an instrument that uses ultrasonic waves to seal the cut end of the veins to avoid bleeding. All trocars are then removed and the wounds are closed. The leg is dressed with an ACE wrap.

After surgery

After surgery, the limb is elevated at 30 degrees for 3 hours, after which walking is allowed. Patients are discharged from the hospital either the same day or the morning after the procedure. After 10 days to 2 weeks, patients may return to work.

Recovery

The patient is generally sent home the same day of surgery and the ACE wrap can be removed in 48 hours. Recovery from this procedure is rapid with a return to normal function within a week. Walking is permitted throughout this recovery period and pain associated with this procedure is minimal. For those patients who present with leg ulcers, healing of these ulcers is markedly accelerated with the reduction of venous pressure subjected to the skin and ulcer area.