Redo subfascial endoscopic perforator vein surgery: does it need to be done if necessary?

Abstract

Background: In this study, we aimed o evaluate the efficacy of redo subfascial endoscopic perforating vein surgery (SEPS) in patients with recurrent venous ulceration who underwent SEPS previously due to venous ulcers with wound healing and relapsed after a period later. Methods: Between May 2003 and November 2011, 32 (7.3%) of a total of 438 patients who underwent SEPS developed recurrence of venous ulcers. All patients were evaluated by venous Doppler and the patients with a history of deep venous thrombosis underwent additional ascending venography. Patients with informed consents was operated by endoscopic method under spinal anesthesia, using 10 mm diameter with a 10 cm incision to medial and with CO2 insufflation 2 cm far from the previous incision scar, re-entering the 10 mm port area of subfascial with the gastrocnemius muscle Perforator veins were ligated using 10 mm titanium clips in subfascial space. Results: Fourteen cases were redo-SEPS. Eighteen patients were treated with wound-care products. Nine of 14 wounds (64.3%) were completely recovered. Five wounds (35.7%) were not healed. None of the patients had any adhesions in the subfascial space. Dissection was able to be constructed easily. Perforator veins which were ligated before were seen at subfascial space. The number of per clip for a new perforator vein was one or two per patient. There was no technical difficulty. There was no complication or mortality. Conclusion: In patients with recurrent venous ulcers despite prior SEPS, redo-SEPS can be safely performed, if necessary.