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Indian Journal of Surgery, Vol. 65, No. 6, November-December, 2003, pp. 519-520 Point in Technique Alternatives to metal strippers for varicose vein stripping D. Premkumar, M. Palainappan, R. Muthussamy, C. Nandagopal Department of Surgery, Perundurai Medical College, Perundurai - 638053, India.
Paper Received: February 2003. Paper Accepted: May 2003. Source of Support: Nil. How to cite this article: Premkumar D, Palainappan M, Muthussamy R, Nandagopal C. Alternatives to metal strippers for varicose vein stripping. Indian J Surg 2003;65:519-20. Code Number: is03115 ABSTRACT Use of a nasogastric tube for stripping of long saphenous vein described. For smaller veins, use of skin hook for stripping the veins is described. Key words: Varicose vein stripping, Nasogastric tube, Skin hook. INTRODUCTION For stripping the superficial veins of the lower limb during surgery for varicose veins conventionally metal strippers of various types eg. extramural ring stripper of Mayo,1 intraluminal wire stripper of Myers etc. are used. Because of the large acorn head at one end of the stripper, damage to saphenous nerve in long saphenous stripping and damage to sural nerve in short saphenous vein stripping has resulted in the modern trend in favour of using inverting or invaginating instruments eg. rigid metal Oesch pin stripper.2 Also phlebotomy hooks have been described for teasing out small veins which are then avulsed. We describe use of an easily and widely available device, a nasogastric (NG) tube, for stripping of the varicose veins. Also, we have described the use of skin hooks for removing smaller varices. TECHNIQUE Under general or regional anaesthesia the conventional Trendelenburg operation of saphenofemoral (SF) disconnection and ligation of tributaries of the long saphenous vein near the SF junction is performed in the standard manner. The rounded tip of a No. 16 NG tube is introduced from above downward through the open lumen of the long saphenous vein. The tube is pushed down the varicose long saphenous vein which usually does not offer any resistance because of the incompetence of the valves. The tip of the NG tube is felt in the middle of the calf region and a small transverse skin incision is made over it. In the vein containing the NG tube a small longitudinal incision is made and the tip of the tube is retrieved for a length of 1 to 2 cm. The tip of the NG tube is then transfixed to the vein with a stout silk suture; the distal vein is divided and ligated. By pulling on the NG tube in small short jabs at the groin end one can easily strip the long saphenous vein which emerges out of the groin incision in an everted manner (Figure 1). For smaller veins, a long straight skin hook is introduced into the vein (Figure 2a). After passing the instrument the maximum distance, the tip of the skin hook is felt through the skin and a small transverse incision made in the skin at this point, the vein divided, the hook made to engage the vein wall (Figure 2b) and the hook is pulled up. As the skin hook is pulled up the vein telescopes on the skin hook (Figure 2c). The distal portion of the vein may also be removed in similar manner. A crepe bandage is applied after skin wounds suture from the toes to groin level and the patient confined to bed and foot end elevated. Recovery is usually rapid and straightforward. DISCUSSION We have described a novel way of stripping the varicose veins using the universally available NG tube. This method appears safe and simple to practice. More importantly, the soft structure of the NG tube and the absence of a head or acorn used during stripping obviate the risk of nerve damage. REFERENCES 1. Mc Cleland DB, Rintoul RF, Ruckley CV. Operations on blood vessels. In: Rintoul RF, editor. Farqhuarson's Textbook of Operative Surgery. 7th edn. Churchill: Livingstone; 1986. pp. 49. 2. Scurr JH, Philip D. Smith C. Venous Disorders. In: Russell RCG, editor. Bailey and Love's Short Practice of surgery. 23rd edn. Arnold: Williams NS and Bulstrode CJK; 2000. pp. 246-7. © 2003 Indian Journal of Surgery. Also available online at http://www.indianjsurg.com The following images related to this document are available:Photo images[is03115f2.jpg] [is03115f1.jpg] |
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