Endoscopic versus open subfascial division of incompetent perforating veins in the treatment of venous leg ulceration: a randomized trial.
OBJECTIVE
Subfascial division of incompetent perforating veins plays an important role in the surgical treatment of patients with venous ulceration of the lower leg. To minimize the high incidence of postoperative wound complications after open exploration, endoscopic approaches have recently been developed. We carried out a prospective, randomized comparison of open and endoscopic treatment of these patients that was aimed at ulcer healing and postoperative wound complications.


METHODS
Patients with current venous ulceration on the medial side of the lower leg were randomly allocated to open exploration by the modified Linton approach or endoscopic exploration by use of a mediastinoscope.


RESULTS
Thirty-nine patients were randomized, 19 to open exploration and 20 to endoscopic exploration. The incidence of wound infections after open exploration was 53%, compared with 0% in the endoscopic group (p < 0.001). Patients in the open group needed longer hospital stays (mean, 7 days; range, 3 to 39 days) than patients in the endoscopic group (mean, 4 days; range, 2 to 6 days; p = 0.001). Four months after operation, the ulcers of 17 patients (90%) in the open group and 17 patients (85%) in the endoscopic group had healed. During a mean follow-up of 21 months (range, 16 to 29 months), no recurrences were noticed in either group.


CONCLUSIONS
Endoscopic division of incompetent perforating veins is equally as effective as open surgical exploration for the treatment of venous ulceration of the lower leg but leads to significantly fewer wound healing complications. Endoscopic division is therefore the preferred method.
Pierik
E G
EG
Department of Surgery, Hospital de Weezenlanden, Zwolle, The Netherlands.
van Urk
H
H
Hop
W C
WC
Wittens
C H
CH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy; D005260:Female; D006801:Humans; D007871:Leg Ulcer / Q000209:etiology* / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013530:Surgical Wound Infection; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D014689:Venous Insufficiency / Q000150:complications*; D014945:Wound Healing