General Surgery

Varicose Vein Surgery

OPERATION: Saphenofemoral Junction Ligation, Long Saphenous Vein Stripping and Multiple Avulsions
ANAESTHETIC: General / spinal anaesthesia
POSITION: Supine

INDICATION:
Symptomatic varicose veins. [Reflux confirmed on duplex — saphenofemoral junction incompetent / truncal LSV incompetence]. [Symptoms: aching / skin changes / venous eczema / previous superficial thrombophlebitis].

PROCEDURE:
WHO Checklist performed. Varices marked preoperatively with patient standing.

GROIN: Oblique incision in groin crease medial to femoral pulse. Dissection through fascia. Long saphenous vein (LSV) at saphenofemoral junction (SFJ) identified. All tributaries of the SFJ flushed — [number] tributaries individually ligated and divided flush with the junction. SFJ divided and LSV ligated flush with the femoral vein using non-absorbable suture. Femoral vein preserved. Stripper device passed down the LSV to [knee / upper calf].

STRIPPING: Small counter-incision at [knee / upper calf]. Stripper retrieved. Vein stripped in an inverted fashion from groin to [level]. Pin-stripping of calf varicosities [if performed].

AVULSIONS: Multiple stab avulsions performed through 2–3 mm incisions at marked varicosities. Varicose vein segments removed with phlebectomy hooks. Incisions left open or closed with Steri-strips.

Compression applied from foot to groin.

FINDINGS:
Incompetent SFJ with [number] tributaries. Varicosities as marked. [Short saphenous vein — not involved].

EBL: Minimal. COMPLICATIONS: None.

POST-OPERATIVE INSTRUCTIONS:
Class 2 compression stockings for 1 week. Mobilise immediately. Keep leg elevated when sitting. Remove stocking to shower after 48 hours. Outpatient review at 6 weeks.