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 Table of Contents     
LETTER TO THE EDITOR
Year : 2019  |  Volume : 15  |  Issue : 3  |  Page : 277-278
 

Surgical intervention for varicose veins during pregnancy: Is it sensible?


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 Submission02-Aug-2018
Date of Acceptance17-Sep-2018
Date of Web Publication4-Jun-2019

Correspondence Address:
Bhupendra Kumar Jain
KE-92, Kavi Nagar, Ghaziabad - 201 002, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmas.JMAS_197_18

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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

How to cite this URL:
Jain BK, Choudhary D. Surgical intervention for varicose veins during pregnancy: Is it sensible?. J Min Access Surg [serial online] 2019 [cited 2019 Jun 26];15:277-8. Available from: http://www.journalofmas.com/text.asp?2019/15/3/277/252460


Dear Editors,

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[1] 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.[2] 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.[3]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
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.  Back to cited text no. 1
    
2.
Varicose Veins: Diagnosis and Management | Guidance and Guidelines | NICE. Available from: https://www.nice.org.uk/guidance/cg168. [Last accessed on 2018 Aug 01].  Back to cited text no. 2
    
3.
Knowing when not to operate. BMJ 1999;318.  Back to cited text no. 3
    




 

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