Short-Term Efficacy of Inguinal Reoperation for Recurrent Saphenofemoral Incompetence using the Stump Suture Technique.

OBJECTIVES: Neovascularization from the saphenofemoral junction (SFJ) is regarded to be an important cause of clinical recurrence. The ideal treatment of SFJ recurrence is still a matter of debate. Barrier strategies have been implemented to improve surgical outcome by reducing neovascularization. This study analyses the value of inguinal reoperation for recurrent SFJ incompetence using a combined approach of stump suture technique, removal of neovasculates, cauterization of free endothelium, and additional tumescent local anesthesia.

MATERIALS AND METHODS: Patients who underwent groin reoperation for saphenofemoral recurrence were identified from a prospectively collected database and invited to undergo a follow-up examination. The following study objectives were recorded and descriptively analyzed: duplex ultrasound-detectable repeat reflux at the SFJ, clinical recurrence according to recurrent varicosis after surgery classification, quality of life, clinical severity of venous disease, and side effects.

RESULTS: Eighty-three patients (100 legs) attended the follow-up examination after a median time of 16.2 months. A duplex-detected reflux in the groin arising from the common femoral vein was identified in 5% with only 1 leg showing grade 2 neovascularization according to International Union of Phlebology classification. Moderate clinical recurrence (visual analog scale [VAS1-5 ]: 1.6 ± 0.7) was present in 52%. Same site clinical recurrence originating from the SFJ was detected in 3%. Major complications were not observed, and the procedure was highly accepted by the patients.

CONCLUSIONS: This study demonstrates that inguinal reoperation for recurrent saphenofemoral incompetence including a stump suture as barrier has the potential to significantly reduce duplex-detected reflux and same site clinical recurrence accompanied by a high patients' acceptance.