Modified Above-Knee Versus Conventional Great Saphenous Vein Surgery Stripping for Lower Limb Varicose Veins: A Prospective Comparative Study

Abstract

Objective: To compare the clinical outcomes, perioperative parameters, and postoperative complications of modified above-knee versus conventional full-length great saphenous vein stripping in patients with varicose veins.
Study Design: Prospective Comparative study.
Place and Duration of Study: The study was conducted at Holy Family, District Headquarters, and Benazir Bhutto Hospital, affiliated with Rawalpindi Medical University, from March 01, 2024 to March 31, 2025.
Materials and Methods: A total of 212 patients with Clinical-Etiology-Anatomy-Pathophysiology grades C2–C5 and Doppler-confirmed GSV reflux were enrolled and equally assigned to the modified above-knee group (n=106) and the conventional surgery group (n=106). Both procedures were completed with local or neuraxial anesthesia, performed by the same surgical group. Data on operative time, length of stay, incision type, intraoperative blood loss, and postoperative complications were collected.
Results: Baseline characteristics were comparable between the two groups. The modified above-knee stripping group showed significantly shorter operative time (48.7 ± 6.8 minutes vs. 59.1 ± 7.0 minutes, p<0.001) and shorter hospital stay compared with the conventional group. The incidence of postoperative saphenous nerve injury was significantly lower in the modified group (2.3% vs. 27.7%, p<0.001). Rates of surgical site infection, venous thromboembolism, and superficial thrombophlebitis were comparable between the groups.
Technical and clinical success rates exceeded 97% in both groups.
Conclusion: Modified above-knee great saphenous vein stripping demonstrated favourable perioperative outcomes, including shorter operative time, reduced hospital stays, and lower incidence of saphenous nerve injury compared with conventional full-length stripping, while achieving comparable clinical and technical success rates.