The operation

The procedure is usually performed as a day case procedure under general anaesthetic. Prior to the operation the surgeon will mark your veins using a waterproof marker pen after agreeing with you which veins are going to be removed. The operation varies from case to case but most commonly an incision is made in the groin and the leaky communication between the defective superficial vein (the Long Saphenous Vein) and the deeper vein (the Femoral Vein) is tied off (see below).

The defective vein is then stripped by passing a wire (a “stripper”) through the vein and taking it out through an incision at about the knee level. The stripper has a stopper at the end of it and when it is pulled through the knee incision the vein is stripped (see below)

Less commonly if the leakiness is behind the knee, then the communication between the defective superficial vein (the short saphenous vein) and the deeper vein (the popliteal vein) is tied off. The short saphenous vein is not usually stripped.

Further smaller incisions (3-5mm) are made over the lumpy veins (the varicosities) and these are removed using special vein hooks (phlebectomies). Larger wounds require closing the wound with a dissolvable stitch. Steristrips are used to close the smaller wounds overlying the phlebectomies.

 

After the operation

The leg is bandaged from ankle to groin and instructions given to the patient to remove the bandages in a day or two and wear compression stockings for two weeks. The purpose of compression is to reduce bruising and swelling following surgery. The wound should be kept clean and dry for at least 48 hours. Walking is encouraged but driving should be avoided for at least 48 hours. The stitch are usually dissolvable which means there is no need to them removed. Bruising especially on the inside of the thigh is very common and is nothing to be alarmed about.  Discomfort is common but usually subsides over a couple of weeks. Simple painkillers such as paracetamol or ibuprofen are usually sufficient. Most patients take one to two weeks off work to rest and recuperate.

As with any operation there are risks and complications as well as benefits. These include:

• Recurrence of the varicose veins which can occur in up to 3 out of 10 patients over 10 years

• Bleeding, bruising and haematoma (lumpiness under the skin which resolves)

• Infection, especially in the groin incision

• Nerve injury. Sometimes nerves are inadvertently damaged during this procedure. These are usually only sensory nerves which supply skin sensation around the ankle or on the outer aspect of the foot.

• Deep vein thrombosis (uncommon)

• Scarring. Although the wounds usually heal well, people scar in different ways.