[Does obesity modify surgical technics?]

This paper expounds, according to the author's personal experience, the tactical and technical modalities in varicose surgery on the obese patient. The need to remain safe as well as effective leads in particular to a preference for loco-regional anaesthetic (peridural, spinal anaesthetic) over general anaesthetic, and to avoid wherever possible operations on the patient in the ventral decubitus position. For venous complexes of the popliteal space which have to be operated, an extremely precise anatomical schema has to be drawn up, by dint of a very thorough clinical examination, whose results will be further refined using echography and phlebography; in most cases, it will be possible to tackle them postero-internally, the patient in the dorsal decubitus position, or even in lateral decubitus. Special attention is given here, according to the type of varicosity to be operated, the best location for cutaneous incisions and modalities of reclosing, taking into account cicatrization problems encountered in this region.