MINIMALLY INVASIVE VERSUS OPEN SUBFASCIAL PERFORATOR LIGATION IN GREAT SAPHENOUS VEIN VARICOSE DISEASE: A CLINICAL OUTCOME ANALYSIS OF SEPS AND OSPL

Abstract

Background: Chronic venous insufficiency (CVI), which mostly affects the lower extremities, causes varicose veins. Venous flow, symptoms, and prevention of venous ulcers and deep vein thrombosis are the goals of varicose vein treatment. CVI management requires interventions targeting incompetent veins, especially perforator veins that connect superficial and deep venous networks.¹ Subfascial endoscopic perforator surgery (SEPS) is a less invasive alternative to open subfascial perforator ligation (OSPL), which involves larger incisions, wound problems, and a longer recovery time.² SEPS and OSPL are compared in patients with GSV varicose veins with perforator incompetence to demonstrate their benefits and promote evidence-based surgical technique selection. Material and Methods: Institutionally-based interventional two-arm trial compares SEPS and OSPL in the management of great saphenous vein varicosities, conducted in the Department of General Surgery, SVRRGGH, S.V. Medical College, Tirupati, over one year following scientific and ethics committee approval, with a sample size of 60. The study includes patients aged 18–65 years undergoing surgery for varicose veins with involvement of the great saphenous vein, and excludes pregnant or lactating women, morbidly obese patients, those with poorly controlled comorbidities, prior surgery for varicosities on the same leg, and patients deemed unfit for anaesthesia. Results: Sixty patients were randomized equally to SEPS (n=30) and OSPL (n=30) groups. Baseline characteristics, including age, gender, physical activity, BMI, smoking, alcohol use, CEAP class, and Doppler findings, were comparable between groups (all p > 0.05). Mean operative time was significantly longer in the SEPS group than in the OSPL (82.4 ± 15.2 vs 60.1 ± 12.8 minutes, p < 0.001), and early postoperative pain was higher in the SEPS group on day 1 and day 3 (p = 0.032 and p = 0.045, respectively), but similar by day 7. Conclusion: SEPS and OSPL cure GSV varicosities with perforator incompetence safely and effectively, with similar clinical, complication, and long-term outcomes. SEPS features smaller incisions, less tissue dissection, and better cosmetic results but takes longer and causes greater early postoperative pain. Patients who value aesthetics and minimally invasive surgery may consider it. With its reduced surgical time and easier methodology, OSPL is a viable alternative when finances or endoscopic experience are restricted. Choose between the two operations based on patient preference, clinical profile, and surgeon expertise.