Re: “Editor's Choice—Five Year Results of Great Saphenous Vein Treatment: A Meta-analysis”: The Results Call for Guideline Revisions

Abstract

The meta-analysis by Hamann et al. gives results that do not match the current treatment recommendations from multiple organisations, which clearly favour endothermal treatments before foam and open surgery. 1e4 The report of Hamann et al. strongly supports fears presented in a leading article in the British Journal of Surgery in 2016. 5 The 5 year results show that open surgery generates less groin recurrence than laser and foam, and matches laser treatment results in other areas. This was clearly pointed out by the authors, but they failed to draw conclusions from what were for many, unexpected results. In most treatment guidelines open surgery has been removed and is only recommended if endovenous treatments cannot be given. I believe a result like this ought to call for an urgent revision of existing guidelines and a resurrection of open surgery, which has been unjustly discounted. It is now important to reinforce that properly conducted open surgery is still one of the best ways of treating varicose veins and, in fact may cause fewer groin recurrences instead of more, which was the original hypothesis. It is too early to call open surgery a treatment of the past when, from a recurrence point of view, it seems to generate the best long-term results. Not all surgeons have been able to invest in endothermal alternatives, but with these results there is no need to feel ancient or inferior for using the open surgery alternative. Open surgery has also been modernised over time and is today less invasive and traumatic than during the days of Babcock some 100 years ago. From a scientific point of view there is still a place for high ligation and stripping.