Subfascial endoscopic perforator vein surgery (SEPS) modified technique: Subaponeurotic approach without balloon

Abstract

Subfascial Endoscopic Perforator Vein Surgery (SEPS) is one of the best procedures and a minimally invasive option for treating chronic venous insufficiency. We explain our experience with SEPS, which has been turned into a subaponeurotic approach without balloon, and assess the possible advantages of this technique. The subaponeurotic space was entered using the Visiport Plus® (Autusuture, Tyco Healthcare) video‐assisted technique, which shows how the trocar enters through the subcutaneous tissue and superficial aponeurosis of the leg. A blunt retractor was inserted which, together with CO2 insufflation (20 mm Hg), enabled the veins to be dissected. Ligation was performed using tripolar sealing. In no case was a balloon used. There were no incidents such as haemorrhage or subcutaneous emphysema during the procedure. The patients (n = 206) remained in the hospital for less than 24 hours and suffered no post‐surgical complications. Active ulcers were cured, with no relapses, in 100% of cases. This is a very effective method for treating advanced chronic insufficiency because it prevents local damage and the rate of post‐surgical complications is low. Technically it has more advantages because the fact that it does not use a balloon means that it exerts less pressure on the tissues.