[Surgical treatment of recurrences after operations for essential varices]

Among our cases of post-operative recurrent varicose veins, we report here only those cases which required further surgery. Thus we were able to carry out a comparative study of a series of 30 patients who were re-operated on between the 16th of March 1959 and the 16th of March 1966, and 44 patients operated on under the same conditions between the 16th of March 1966 and the 16th of March 1974. The causes of recurrence were different in the two groups. Before 1966, they were mainly due to the choice of inefficacious operations. Since 1966, they are due to poor technique in resection of the junction of the femoral vein with the saphenous vein. This was the most common cause, and these failures were favoured by saphenous abnormalities. Associated with stripping of the large vessels, resection of inguinal cavernoma which prolonged the femoro-saphenous junction, was the main stage in these re-operations. It was perfectly efficacious in the treatment of varicose veins but required also resection of inguinal lymph nodes with the cavernoma. Post-operative complications, such as lymphatic fistula and oedema, led us to prefer simple isolation of the cavernoma from the deep veins, but the first and essential stage remains resection of the junction of the femoral and saphenous veins and stripping of accessory trunks.