title: 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.
authors.affiliation: Sant Joan University Hospital, Reus, Surgery Service, Tarragona, Spain.
authors.forename: Santiago Blanco
authors.initials: SB
authors.lastname: Blasco
authors.forename: Mercé
authors.initials: M
authors.lastname: Hernández González
authors.forename: Fátima
authors.initials: F
authors.lastname: Sabench Pereferrer
authors.forename: Carlos
authors.initials: C
authors.lastname: Diáz Lara
authors.forename: Francisco Buils
authors.initials: FB
authors.lastname: Vilalta
authors.forename: Antonio Morandeira
authors.initials: AM
authors.lastname: Rivas
authors.forename: Daniel Del Castillo
authors.initials: Ddel C
authors.lastname: Del Castillo Déjardin
mesh_terms: D000328:Adult; D000368:Aged; D017546:Angioscopy / Q000379:methods*; D002908:Chronic Disease; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D007902:Length of Stay; D008026:Ligation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012501:Saphenous Vein / Q000601:surgery; D014647:Varicose Ulcer / Q000601:surgery*; D014689:Venous Insufficiency / Q000601:surgery*; D020535:Video-Assisted Surgery / Q000379:methods*