The 9th Edition of the Hands-On Course of Subfascial Endoscopic Perforator Surgery - SEPS DAY - was again held in Hospital de Castelo Branco (Portugal), on the 16th of November 2023 (pictures). Four fantastic surgeons were with us, learning the technique and some tips and tricks. It was a great learning morning with two patients being operated on to treat incompetent perforators.
Incompetent perforators of lower limbs are responsible for varicose veins, for the recurrence of varicose disease, and are implicated in varicose ulcers. Treating incompetent perforators will decrease varicose veins' recurrence, and will promote the healing of a venous ulcer while decreasing its recurrence. Many patients can not heal their ulcers because they are not offered the treatment of incompetent perforators.
There are different techniques to treat incompetent perforators. Do they have the same results? No, they do not. Subfascial Endoscopic Perforator Surgery (SEPS) is associated with a healing rate of up to 96%, which is higher than any percutaneous ablation of perforator (PAP) technique (Laser, RF, Sclerosis). With follow-up, perforators treated with Laser or RF tend to re-open. Additionally, PAP techniques are ultrasound-dependent, meaning the surgeon will only treat those perforators found during the ultrasonography. However, during SEPS surgeon finds more 2-3 perforators than in the ultrasound. In sum, by using SEPS we are able to treat more perforators, which would be untreated when using PAP techniques.
The advantage of PAP techniques is the low invasiveness compared with SEPS. However, SEPS is a safe and fast procedure that takes only 15 min and can be performed in an ambulatory setting. SEPS has a low rate of complications, treats perforators under lipodermatosclerosis, and treats perforators under an active ulcer. These are the major advantages of SEPS.
During the 9th Edition of SEPS DAY, we demonstrated these advantages by treating a patient with a C5 disease where we were able to ligate huge perforators under the diseased skin, without any local puncture or incision. In fact, SEPS only needs two small incisions away from the lipodermatosclerosis or ulcer. This is a great advantage. For us, SEPS is the way to treat perforators, decrease varicose veins' recurrence, and promote varicose ulcers' healing.
Remember, the 10th Edition of SEPS DAY - LA DECIMA - will be announced. If you want to register on the waiting list for SEPS DAY - LA DECIMA send an email now: sepsday@yahoo.com
Dr. Carlos Eduardo Costa Almeida
General Surgeon
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