Subfascial perforator vein ablation: Comparison of open versus endoscopic techniques

Purpose: To compare the outcomes and complications of open (OSPS) versus en doscopic subfascial perforator surgery (SEPS) for treatment of chronic veno us insufficiency. Methods: Data were retrospectively collected on 25 patients who underwent 2 7 SEPSs from February 1996 to August 1997 and from 22 patients who underwen t 29 OSPSs between March 1978 and May 1993. Outcomes were evaluated for pos toperative complications, ulcer healing, recurrence, and venous dysfunction scores on the last follow-up for the SEPS group and at 1-year follow-up fo r the OSPS group. Results: The 2 groups were similar in age, sex, history of previous venous surgery, healed or active ulcers, etiology, deep venous incompetency, patho physiology, and venous refill times. Eighteen (90%) of 20 active ulcers in the SEPS group healed with recurrences in 5 (28%) limbs at 7.5 +/- 5.4-mont h follow-up. All 19 ulcers in the OSPS group healed, with recurrences in 13 (68%) limbs at 35 +/- 35-month follow-up. Clinical venous dysfunction scor es showed significant improvement following SEPS (10.0 +/- 3.6 to 5.4 +/- 4 .1,p < 0.001) and OSPS (10.0 +/- 3.2 to 6.7 +/- 3.6, p < 0.001) with no sig nificant difference between groups. Both groups also had significant improv ement in anatomical and disability scores. There was no postoperative morta lity in either group. The OSPS group had significantly more wound complicat ions (45%) than the SEPS group (7%) (p < 0.005). The hospital stay and read mission rate for wound problems were also higher in the OSPS group. Conclusions: The early outcome showed equal improvement in clinical venous dysfunction scores in the 2 groups, but with significantly fewer complicati ons in the SEPS group. Although the long-term durability of the endoscopic approach has not been determined, the short-term results would favor SEPS f or treatment of severe venous insufficiency when perforator incompetence is a significant component.