LETTER TO THE EDITOR
|Year : 2019 | Volume
| Issue : 3 | Page : 277-278
Surgical intervention for varicose veins during pregnancy: Is it sensible?
Bhupendra Kumar Jain1, Deepti Choudhary2
1 Departments of Surgery, Red Cross General, Maternity, and Child Welfare Hospital, Delhi, India
2 Departments of Obstetrics and Gynaecology, Red Cross General, Maternity, and Child Welfare Hospital, Delhi, India
|Date of Submission||02-Aug-2018|
|Date of Acceptance||17-Sep-2018|
|Date of Web Publication||4-Jun-2019|
Bhupendra Kumar Jain
KE-92, Kavi Nagar, Ghaziabad - 201 002, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jain BK, Choudhary D. Surgical intervention for varicose veins during pregnancy: Is it sensible?. J Min Access Surg 2019;15:277-8
Surgery for the varicose veins in pregnancy is, of course, a novel idea. However, the article by Sahoo et al. proposing subfascial endoscopic perforator surgery (SEPS) for treating varicose veins during 2nd trimester of pregnancy needs a fresh look to assess whether this surgery is sensible during pregnancy. A few more details by the authors could have enhanced the scientific value of the article. Was the study approved by the Institutional Ethical Committee? The authors could recruit 45 young pregnant women for surgery for varicose veins in a period of 4 years. What was the duration of symptoms? How many patients were having varicose veins before getting pregnant? The details, regarding the trial of the conservative method of treatment before surgery – if any, should have been mentioned. The authors have not disclosed the diagnostic modalities used to verify the venous abnormality, and the findings of these investigations. Were the patients informed that the varicose veins may regress in the postnatal period? What was the status of saphenous veins in these patients and what was done to correct abnormality of these veins? What was the justification of operating during pregnancy 5 (11%) patients who were clinically silent (sic)? The proportion of these young women presenting with ulceration and bleeding (48.9%) is unusually high. The authors state that there was significant pain relief in all the patients, whereas, only 18 (40%) patients presented with discomfort – none with pain. What method/score were used to assess pain? What is the rationale behind calling the procedure safe without providing the data regarding the outcome of pregnancies, and complications related to pregnancy and the child. The authors could not document any earlier instance of the use of surgical methods for the treatment of varicose veins in the leg during pregnancy.
NICE guidelines provide valuable insight in this matter. Varicose veins affect about 40% of pregnant women. Although varicose veins may appear during pregnancy, there was a possibility that these would regress in the postnatal period. The pregnant women should be informed about this possibility. During pregnancy, the primary concern is safety for the woman and the unborn child; treatment of varicose veins is not advised in the pregnant women. Intervention treatment of varicose veins should not normally be offered to a woman during pregnancy. In exceptional circumstances such as bleeding varicosities, interventions could be considered. These patients should be referred to a vascular surgeon for their assessment of the risk and benefits of the interventional treatment.
It is our considered opinion that the quality of the outcome of the study by Sahoo MR et al. is low on multiple counts. At present, state of knowledge, routine surgical intervention for varicose veins during pregnancy is unwarranted. We would like to caution your esteemed readers against SEPS during pregnancy. Good surgeons know how to operate, better ones when to operate, and the best when not to operate is an old saying in the field of surgery, and it holds true even in the management of varicose veins.
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Conflicts of interest
There are no conflicts of interest.
| ¤ References|| |
Sahoo MR, Misra L, Deshpande S, Mohanty SK, Mohanty SK. Subfascial endoscopic perforator surgery: A safe and novel minimal invasive procedure in treating varicose veins in 2nd
trimester of pregnancy for below knee perforator incompetence. J Minim Access Surg 2018;14:208-12.
Knowing when not to operate. BMJ 1999;318.