BACKGROUND: Minimally invasive techniques to treat great saphenous varicose veins include ultrasound-guided foam sclerotherapy (USGFS), radiofrequency ablation (RFA) and endovenous laser therapy (EVLT). Compared with conventional surgery (high ligation and stripping (HL/S)), proposed benefits include fewer complications, quicker return to work, improved quality of life (QoL) scores, reduced need for general anaesthesia and equivalent recurrence rates. The full text is available from: http://dx.doi.org/10.1002/14651858. CD005624.pub2.The abstract is also available in the Portuguese, French and Spanish languages from: http://summaries.cochrane.org/pt/CD005624/ablacaoendovenosa-por-radiofrequencia-e-laser-e-escleroterapia-com-espumaversus-cirurgia-convencional-para-o-tratamento-de-varizes.
COMMENTSWith the advent of new techniques for treating varicose veins, many studies are needed in order to compare the new procedures with the gold-standard treatment, i.e. conventional surgery with removal of either the great or the small saphenous vein and excision of tributaries presenting insufficiency. In this review, many data were flawed or did not lead to a conclusion that would be capable of showing significant details regarding the best technique. It can be expected that treatments with laser, radiofrequency or foam sclerotherapy may lead to recanalization of the treated veins, since these do not remove the veins but only stop the flow of blood through the lumen. Recurrence of varicose veins within four months suggests that there was an error in marking out the varicose veins before the operation and failure of the planned removal of the saphenous vein or the dilated tributaries. Some technical details of the surgery may differ, such as segmental removal of the great saphenous vein under general anesthesia. This procedure is not customary in many centers, and complete removal of the saphenous vein with intrathecal or regional blockade is preferred. Other extremely necessary data include comparison of the costs of the fiber laser and radiofrequency equipment, costs of procedures and costs of hospitalization when necessary.
Social deprivation is significantly associated with postoperative length of stay and survival in patients undergoing pelvic exenteration for primary rectal cancer.
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