Experience of Subfascial Endoscopic Perforator Surgery (SEPS) for Treating Venous Ulcers at Tertiary Care Hospital, Lahore

Abstract

Objective: To evaluate the outcome and post-operative complications of subfascial endoscopic
perforator surgery (SEPS) for treating venous ulcers and skin changes associated with chronic
venous insufficiency.
Methods: This was a prospective cross sectional survey which was conducted at surgical
department of Sir Ganga Ram Hospital Lahore from September 2014 to March 2017. A total of 63
subfascial endoscopic perforator ligations were performed on 63 limbs of the patients.
Quantitative data was presented using mean±SD. Qualitative data was presented using
frequency table and percentages. Patient follow-up was scheduled at 2 weeks, 1 month,
6months, 12 months and 24 months.
Results: Mean age of patients was 40.7 years. Male female ratio was 6:1. The most frequent
symptom at presentation was pain in the leg (66.7%) and the most frequent sign was skin
changes with active ulcer (61.9%). 39 patients had incompetent saphenofemoral junction with
incompetent perforating veins while 24 patients had incompetent perforating veins alone. Mean
operative time for the SEPS was 66.9 minutes. Average postoperative pain score was 5. Early
postoperative complications included hematoma in 14.2% of patients, edema in 28.7%, surgical
emphysema in 28.6%, and saphenous neuralgia in 4.76% and wound infection in 1.6% of
patients. There were no early deaths, and there was no clinical evidence of thromboembolism
within 1 month of the procedure. At 6 months follow up skin changes were improved in 95% of
patients, active ulcers were healed in 100 % of patients and there was no recurrence of ulcers at
24 months postoperatively.
Conclusions: SEPS is minimally invasive technique for management of venous ulcers
leading to early patient mobility, early return to work, better ulcer healing and no ulcer recurrence