[Surgical treatment of varices--principles and current status]

The basis of surgical treatment for varicose veins is still the stripping operation. This operation consists of four components: The "crossectomy", the stripping propper of the greater or smaller saphenous vein, the ligation of the incompetent perforating veins and the removal of the side branches. However this complete stripping procedure is not always necessary or suitable. Combination of one or two components of this operation with other techniques such as sclerotherapy may lead to results almost or just as good as the complete conventional stripping operation. These combinations are usually less invasive and often less costly. However in many instances comprehensive surgical treatment is still preferred. Then the present trend is to make also this treatment less invasive, both surgically and cosmetically. A number of new surgical technical details allow for a reduced invasivity: The endoscopic procedure for the incompetent Cockett perforating veins permits at the same time their diagnosis and treatment. It is done from a small incision below the knee. The technique of phlebectomy with incisions only 2 to 5 mm long is less invasive and produces better cosmetic results. Instead of closing the wounds with sutures, small incisions up to 1 cm long can be closed with elastic adhesive bands. They work on a convex surface according to the tension band principle. Due to their isoelasticity they seldom cause skin problems. These techniques are facilitated by the bloodless limb technique with a pneumatic tourniquet. In extensive cases this technique also saves blood to the patient and facilitates surgical precision. The newer diagnostic techniques help the surgeon to be more certain about his diagnosis. This in turn improves his results and again reduces invasivity. Many surgeons rely mostly on phlebography, but duplex sonography is picking up. It is estimated that all these factors reduce the invasivity of surgery of varicose veins by 50 percent, allows for better cosmetic results and by this makes the treatment more attractive for the patient.