Dr.G.Diaconu-varices ,hernia , crossectomy





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Uploaded on Dec 1, 2011

Dr. G. Diaconu, M.D.,
The County Emergency Hospital "Sf. Andrei"
Galați, România

Crossectomy of the great saphenous vein by inguinal approach is not a goal in itself. It was performed in 2010 -- 2011 in 3 cases on two patients in their 70s, having essential varices of the great saphenous vein, a female (D.G., 75) having right incarcerated crural hernia (epiplomerocele) and a male (B.G., 78) also having bilateral direct inguinal hernia. The great saphenous vein compartment was opened cranially in all cases and the crossectomy was performed through the inguinal incision.
The 3 surgical operations were performed using this technique, on two patients:
1. Female, 75 years old -- one operation: crural right hernioraphy (Mac Vay) by inguinal approach and great saphenous vein crossectomy by right inguinal incision.
2. Male, 78 years old -- two operations at a 10 months interval:
a. Lichtenstein right inguinal hernioplasty and right great saphenous vein crossectomy by right inguinal incision;
b. Lichtenstein left inguinal hernioplasty and left great saphenous vein crossectomy by left inguinal incision;
For both patients saphenectomy by discontinuous incisions, resection of varicose packs and subfascial ligatures of perforant veins were performed during the same operation. The male also presented several calf distal open ulcers fed by the calf anterior saphenous vein.
On admission the female had a right crural incarcerated hernia and essential varices of the great saphena and the male had bilateral inguinal hernia and bilateral essential great saphenous vein varices with varicose calf distal ulcers. On discharge from hospital, both patients had their inguinal incision wounds healed, and the male had his varicose ulcers closed with sero-hematic crusts.
The use of the technique described above ensures on the one hand a higher degree of comfort for the patient, by performing two operations in one surgical intervention, and on the other hand a better management of resources, the duration and costs of hospitalisation being reduced by about 1/3.

For details, see:
Diaconu G. -- Varicele membrelor inferioare -- corelaţii anatomo-clinice şi terapeutice, teza de doctorat, Iaşi, 2009


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