Postoperative Komplikationen nach inguinaler Re-Krossektomie

Abstract

The surgical procedure for recurrences at the saphenofemoral junction represents a great challenge for the surgeon due to the complex anatomic variability, the broad range of causes and the mostly extreme scar tissue. The incidences of postsurgical minor and major complications after recrossectomy in the groin area are determined and the clinical outcomes are analysed in this article. After specific and precise presurgical clinical and sonographical diagnoses having been undertaken a cutaneous incision is performed in the groin with the aid of tumescent local anaesthesia combined with total intravenous anaesthesia. From the proximal site any scar tissue exsisting is meticulously removed, the femoral vein is set free and the still remaining stump of the long saphenous vein or of the neovasculate as well as all left over varicose side branches of the saphenofemoral junction are removed. Within this special surgical procedure the stump of the long saphenous vein or the neovasculate are completely removed and, thereafter, a continuous longitudinal suture of the femoral vein is performed. Uncomplicated minor bleeding complications (haematoma in large extension or disseminated) appear quite frequently, lymphatic minor complications (conservatively treatable lymph oedema, lymphatic fistulae or lymphatic cysts) occur from time to time; major complications such as bleeding complications with the necessity of surgical reintervention occur only in sporadic cases and can be avoided by exact presurgical diagnosis, by meticulous special surgical technique matching the operation site as well as by regular and frequent postsurgical follow-ups. Absolute preconditions to achieve the very best results in the long run are the exact procedures of diagnosis and surgical technique. Performed by experienced phlebosurgeons or vascular surgeons, the recrossectomy of the saphenofemoral junction represents a low-risk surgery for the patient and is a singular and possibly time-consuming challenge for the surgeon.

Zweijahresergebnisse einer prospektiv-randomisierten kontrollierten Multicenterstudie zum Vergleich der offen operativen Therapie vs. der lasergestützten endoluminalen Therapie mit und ohne Crossektomie zur Therapie der Varikose der V. saphena magna

“…In einer Auswertung der perioperativen Ergebnisse konnte gezeigt werden, dass im Vergleich der beiden Verfahren kurzfristig klinisch gleichwertige Ergebnisse erzielt werden kön-nen [1]. Zur Frage steht, ob diese Ergebnisse nachhaltig sind, sollte das Ziel für die Patienten doch darin bestehen, Rezidiveingriffe an der Magnacrosse zu vermeiden, auch wenn diese in geeigneter Hand einen risikoarmen Eingriff darstellen [2]. In dieser Situation wurde mit der Deutschen Gesellschaft für Phlebologie (DGP) eine Studie initiiert, die statistisch belastbare Ergebnisse erbringen sollte.…”