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

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. 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. 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. 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.