DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Primary varicose veins, left lower extremity.
Primary varicose veins, left lower extremity.
POSTOPERATIVE DIAGNOSIS:
Primary varicose veins, left lower extremity.
Primary varicose veins, left lower extremity.
OPERATION PERFORMED:
Left lower extremity varicose vein stripping and excision.
Left lower extremity varicose vein stripping and excision.
SURGEON: John Doe, MD
ANESTHESIA: General with endotracheal intubation.
DESCRIPTION OF OPERATION: The patient was taken to the operating room after the multiple large varicosities in the left lower extremity had been marked. The bulk of the large varicosities were present in the left posterior calf. Consequently, the patient was initially placed in the prone position for access to the posterior calf varicosities and was later converted to the supine position for stripping of the greater saphenous vein. A Foley catheter was inserted. The patient was then positioned on the operating room table in prone position. Rolls were placed on both sides of the chest. The left lower extremity was then prepped in the usual circumferential fashion. Sterile drapes were applied. Multiple transverse and vertical incisions were then made in the left popliteal fossa and in the posteromedial calf. The very large, tortuous varicosities were individually dissected and removed. Perforating veins were ligated with 3-0 suture prior to division. The dissection was continued on the medial and lateral sides of the calf. As much of the marked varicosities were removed from this approach. Varicosities in the left lower posterior thigh were also individually dissected and removed. After completion of the dissection, the multiple incisions were closed with interrupted 5-0 nylon. The patient was then repositioned for the supine approach. The left lower extremity was again prepped with Betadine solution and draped in the usual sterile fashion. A transverse incision was made in the left groin. The large proximal greater saphenous vein was identified. This was dissected to its origin with the common femoral vein. Tears were ligated with 3-0 silk suture and divided. The greater saphenous vein was then ligated flush with the common femoral vein using a 2-0 silk suture. The proximal greater saphenous vein was then divided. Attention was then turned to the left medial ankle. A transverse incision was made anterior to the medial malleolus. The greater saphenous vein was identified at this level. The vein was separated from the adjacent nerve. The distal greater saphenous vein was then ligated with 3-0 silk suture. An incision was made in the vein and a plastic stripper was advanced to the medial knee. The stripper would not go beyond the knee, so a vertical incision was made at the tip of the stripper in the upper calf. The stripper in the vein was identified. This was secured in the vein with 2-0 silk suture. The greater saphenous vein was then stripped from the knee out the ankle incision. Pressure was held along the course of the vein for hemostasis. After division of the greater saphenous vein in the groin, the plastic stripper was advanced distally to the medial knee. The vein containing the stripper was identified. The greater saphenous vein was then stripped from the groin to the knee in the usual fashion. Pressure was held along the course of the saphenous vein for hemostasis. At the completion of the dissection, no significant bleeding was noted. There was no hematoma. The multiple incisions were closed with interrupted 5-0 nylon. The groin incision was closed with interrupted 3-0 plain catgut in the subcutaneous layer and subcuticular 5-0 Vicryl for the skin closure. The estimated blood loss was less than 100 mL. The sponge count was correct. No blood transfusions were administered. A bulky fluff gauze dressing was applied to the left lower extremity and secured in place with Kerlix rolls, 4 and 6 inch elastic Ace bandages. The patient tolerated the procedure without difficulty and was awakened from the anesthetic in the operating room and extubated. The Foley catheter was removed. The patient was then transferred to the surgical recovery area in stable and responsive condition.
