DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Varicose veins, left leg, symptomatic.
POSTOPERATIVE DIAGNOSIS: Varicose veins, left leg, symptomatic.
PROCEDURES PERFORMED:
1. Left leg greater saphenous vein stripping, below the knee.
2. Left leg varicose vein excision using a TriVex system.
SURGEON: John Doe, MD
ASSISTANT: None.
ANESTHESIA: General.
COMPLICATIONS: None.
BLOOD LOSS: Nil.
SPECIMENS: None.
INDICATIONS FOR PROCEDURE: This is a (XX)-year-old woman who is status post gastric bypass surgery. She has suffered from painful varicose veins. She has a history of restless leg syndrome and has had paresthesias in the left leg and foot prior to surgery. She had been seen by Neurology and is under treatment for her restless leg syndrome, but her varicose veins are quite painful, and she now desires their excision. We discussed the surgical procedure as well as the risks and complications, including bleeding, infection, and recurrence. We also discussed the possibility of DVT and the need for possible admission. The patient understands these risks and agrees to proceed.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room, placed in the supine position, and given anesthesia. The left leg was prepped and draped sterilely. The greater saphenous vein was identified at the ankle, and a skin incision was created over it. Subcutaneous tissues were dissected, and saphenous vein was identified and encircled with 0-silk ties.
A small opening was created in the vein, and a stripper was placed into the vein and passed up the leg. It was passed to the level of the knee where a second incision was created. The decision was made to strip only below the knee, as she had no varicose veins above the knee. The incision was created over the palpable stripper. The vein was identified and encircled with silk ties. It was ligated proximally and was ligated over the stripper, and then a small venotomy was created, and the stripper was brought out to this venotomy. The end of the stripper was attached, and the vein was stripped out of the leg. It was sent for pathologic evaluation.
At this point, several incisions were created, and using the TriVex system, the varicose veins were excised by transillumination. The tumescent fluid, which contained epinephrine and lidocaine, was also instilled into the leg to minimize any swelling or bruising. Once the varicose veins, which had been marked, were completely excised, the skin incisions were closed with 4-0 Monocryl, and sterile dressings were applied. A pressure dressing of Kerlix and Webril were placed on the leg, and an Ace wrap was placed over the top of that. There were no complications.
