St Richard's Hospital Vascular Unit                         Royal West Sussex NHS Trust

This procedure is typically performed as a day case. This means that you will be discharged on the same day of surgery. Suitability for day surgery does not only rely on the type of surgery but also on your fitness and social circumstances.  Your suitability for day surgery is first assessed by the surgeon who booked your procedure. Before your operation date, you will be seen by a member of staff at the day surgery unit (DSU) to ensure that you remain suitable for day surgery.

On the day of surgery, you will be admitted to the DSU. Your veins will be marked and we will go through the consent form with you again. The anaesthetist will then see you and will talk with you about your anaesthetic. You will then be taken to the operating theatre and anaesthetised. The operation itself involves a 3-5 centimetres incision in the groin-crease to expose the upper end of the long saphenous vein. The vein will then be disconnected from the deeper system and stripped by using a special instrument. To remove the vein, a small 0.5-1 centimetre vertical incision is made below the knee. Once the main vein is removed, the surgeon will start to remove the remaining smaller veins via very small vertical incisions between 1 and 3 millimetres in length. When the procedure is complete, the groin wound is infiltrated with local anaesthetic and closed in layers using completely absorbable suture material. The remaining wounds are closed using adhesive tape. Your leg(s) will then be bandaged firmly.

After surgery, you will be transferred to a recovery bay. Once you are fully recovered, you will be taken back to your original bed for a further period of rest.  You will then be allowed to eat and drink. At this stage, you may start to feel some discomfort from your operation. This is expected and usually responds quickly to pain killers. If all is well, a specially trained nurse will provide you with a compression stocking and will discharge you. You will be advised to wear these stockings continuously for the first two weeks and for the time you are out of bed for the following four weeks. Normally, you will not be given a follow up appointment. However, if you or your doctor feel that you need to be seen again, this can be arranged by contacting us.

Following discharge, you will be expected not to drive for 7 to 10 days as your ability to perform emergency breaking will be impaired. You are encouraged to walk for at least half an hour every day. For the first four days following surgery, you are allowed to shower provided you keep your wounds dry. After four days you are allowed to shower freely provided you dry quickly. The adhesive tape will start to fall off at this stage. For the first week, you must avoid prolonged periods of standing as well as certain types of sports such as swimming, cycling and running.                          

Sapheno-femoral junction tie and long saphenous vein stripping is associated with the following possible complications:

• Recurrence: whilst this is not a complication as such, it is important to realise that there is a significant tendency of varicose veins to return. This is estimated to be around 10-15%. The recurrence is usually due to appearance of new sites of incompetence.

• Wound infection: the incidence of wound infection ranges between 1 to 3%. Groin wounds are particularly susceptible. The extent of infection can vary from superficial requiring only antibiotics to deep requiring readmission for antibiotics and drainage.

• Bleeding / Haematoma formation: some of the wounds may continue to bleed after surgery. This can be treated by direct compression and leg elevation. A haematoma is a collection of blood under the skin. This is a form of contained bleeding. Haematomas appear as  lumps under the skin which can be surrounded by a bruise. These can be particularly uncomfortable. Given time, the lumpiness and the bruising disappear completely.

• Saphenous nerve injury: the saphenous nerve is a small sensory nerve that runs close to the great saphenous vein below the knee. This nerve carries sensation from the area of skin on the inside of the foot. Injury to this nerve during low stripping or avulsions can lead to numbness to its area of supply. This numbness can be temporary or permanent.

• Deep venous thrombosis: the incidence of deep venous thrombosis (DVT) following varicose vein surgery is very low. Wearing the compression stockings and remaining active following surgery minimise the risk. 

• Permanent ankle swelling: this is a very rare complication (0.5% incidence). Interruption of the lymph channels during surgery is inevitable. In those patients who have a deficiency of these channels which is not clinically manifest, groin surgery can induce this deficiency to manifest itself.

Admission:          Day of Procedure 

Anaesthetic:        General / Spinal

Stay in hospital:  4-24 hours

Time off work:     1-2 weeks

First follow-up appointment:  6 weeks for recurrent surgery

                                                        None for first time surgery

Bilateral great saphenous varicose veins marked prior to surgery.

The varicose veins are preoperatively marked whilst the patient is standing. Duplex marking was also required for this patient.

The majority of the veins are removed via "microincisions". These are usually 1-2mm in length.

The varicose veins are "hooked" out through these small stabs. 

Following removal of the veins, the microincisions are simply closed using adhesive tape.