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

As with most other types of venous surgery, 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 Day Surgery Unit. You will either have had your veins duplex marked the day before, or would be asked to present to the Radiology Department for marking on the day of your surgery. You will then be seen by your surgeon who will mark more of your veins and will go through the consent form with you. The anaesthetist will then see you and will discuss with you the proposed type of anaesthesia. You will then be taken to the operating theatre and anaesthetised. The operation involves a 3-5 centimetres transverse incision in the area behind knee. The exact site of this incision will be determined by the pre-operative scan. The junction between the short saphenous vein and the deeper veins will be identified and ligated. Further multiple very small vertical incisions between 1 and 2 millimetres in length may be required to remove the superficial veins. The main wound will be infiltrated with local anaesthetic then closed in layers with 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-popliteal junction tie 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%. The extension 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 disappears.

• Sural nerve injury: the sural nerve is a sensory nerve that runs across the field of surgery. This nerve carries sensation from an area of skin overlying the calf. This nerve can become injured either directly or indirectly by retraction on the wound edges. Injury to this nerve leads 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 an extremely rare complication. Interruption of the lymph channels during surgery is inevitable. In those patients who have a deficiency of these channels, which is not clinically manifest, surgery to this area can induce manifestation. This complication is less likely to occur than with Long saphenous venous surgery.

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

A preoperatively marked site of recurrence. Note that previous surgical scar is well away from the marked site. This highlights the fact that short saphenous venous surgery is much more difficult and accurate marking is essential for its success.