Laparoscopic Procedure

What is Laparoscopic surgery?

Laparoscopic surgery is also called minimally invasive surgery (MIS) or keyhole surgery. It is a specialized surgical technique in which operations in the abdomen are performed through small incisions or ports usually 0.5–1.5 cm. A large single incision is carried out in traditional open surgery procedures. Keyhole surgery uses images displayed on TV monitors for magnification of the surgical elements. Laparoscopic surgery can also be used for operations within the abdominal or pelvic cavities. Keyhole surgeries performed on the thoracic or chest cavity are called thoracoscopic surgery.

Laparoscopic surgery versus Open surgery

Open surgery Laparoscopic surgery
8 – 10 inch single incision Multiple 1/4 or 1/2 inch incisions
Tedious post-operative recovery Less post-operative recovery
Long hospital stays Short hospital stay
More need of narcotics and
medications for recovery
Less need of narcotics and medications
for recovery
Higher amount of wound
complications such as infections
Less amount of wound complications
Excessive bleeding with blood transfusion Less bleeding and no blood transfusion
Over-exposure of internal organs and susceptibility to external contaminants
and infections
Reduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections.

The Digital laparoscope

The laparoscope is a long, thin, fiber optic cable like a telescope which illuminates and magnifies the structures inside the abdomen. There are two types of laparoscopes:

Telescopic rod lens system: The telescopic rod lens system is a device which uses a single chip or three chip video camera connected to it.

Charge-coupled device: In the digital laparoscope the charge-coupled device is placed at the end of the laparoscope instead of the telescopic rod lens system.

A fiber optic cable system is attached which is connected to a ‘cold’ light source such as halogen or xenon. These are inserted through a 5mm or 10mm cannula or trocar to view the operative field. After prepping, the abdomen is insufflated with carbon dioxide gas. This elevates the abdominal wall above the internal organs like a dome creating a working and viewing space. CO2 is used because it is common to the human body and can be absorbed by tissue and removed by the respiratory system. It is also non-flammable, which is important because electrosurgical devices are commonly used in laparoscopic procedures.

A vast majority of the abdominal operations can be done by laparoscopy with excellent results, minimum pain and quick recovery.

We have extensive experience in :

  • Laparoscopic Cholecystestomy (REMOVAL OF GALL BLADDER WITH STONE)
  • Laparoscopic Appendictomy (REMOVAL OF APPENDIX)
  • Laparoscopic Colonicresection ( REMOVAL OF PART OF COLON)
  • Laparoscopic AP resection(REMOVAL OF RECTUM)
  • Laparoscopic Rectopexy(FIXING PROLAPSED RECTUM)
  • Laparoscopic Cardiomyotomy (FIXING NARROWED FOOD PIPE)
  • Laparoscopic Fundoplication( FIXING DILATED FOOD PIPE)
  • Laparoscopic Esophageal surgery
  • Laparoscopic Diaphragmatic Hernia Repair
  • Laparoscopic Ventral Hernia Repair
  • Laparoscopic Inguinal hernia Repair
  • Laparoscopic cystogastrostomy
  • Laparoscopic splenectomy
  • Laparoscopic Bariatric Surgery And many more Laparoscopic surgery

Surgery for gastric ulcer

Peptic ulcers are caused by Helicobacter Pylori. A large gastric ulcer in the lining of the stomach presents with severe upper abdominal pain and vomiting. Quite often these ulcers heal by medication. These ulcers can bleed massively requiring transfusion of blood and sometimes surgery. Surgery for ulcers will be in the form of partial gastrectomy called as Gastric Surgery.

Surgery for duodenal ulcer

Duodenal ulcers can cause bleeding or sometimes gastric outlet obstruction causing persistent vomiting. An anastomosis between the stomach and the proximal loop is created for draining the contents of the stomach. Surgery for this ailment will be in the form of gastro-jejunostomy and truncal vagotomy

Surgery for cancer of the stomach

Cancer of the stomach is a very common ailment in southern India. Cancer of the stomach is in the form of a malignant tumor developing in the stomach. Stomach cancer is also called gastric cancer. These patients present with a varied presentation which includes weight loss, pain abdomen, vomiting or sometimes with no symptoms at all. An upper GI endoscopy is usually diagnostic. Cancer of the stomach will primarily require surgery in the form of partial, total gastrectomy or bypass followed by chemotherapy if necessary.

Surgery for corrosive injury of the stomach

Acid injury to the stomach due to accidental or suicidal ingestion of bathroom acid causes severe damage to the stomach, which will require emergency or elective surgery on the stomach like Bypass Gastric Surgery and

Gallbladder and Biliary Tract Surgery

Gallbladder stones are an extremely common disorder and are usually asymptomatic. Some patients experience biliary colic, an intermittent and often severe pain in the epigastrium or right upper quadrant, and at times between the scapula because of temporary obstruction of the cystic duct with a gallstone. If the cystic duct obstruction persists, the gallbladder becomes inflamed and the patient develops cholecystitis, an acute inflammation and infection of the gallbladder. The vast majority of patients with gallstones are asymptomatic.
Some common ailments of gallbladder and bile duct are as follows:
Gallstones are formed when bile salts become hard particles and create blockage.
Cholecystitis is an acute and chronic inflammation.
Acute cholecystitis could be the result of tumors and other illnesses.
Chronic cholecystitis is caused due to shrinkage of the gallbladder due to repeated acute cholecystitis and loses its functionality.
Choledocholithiasis occurs when the gallstones are lodged in the bile ducts or the neck of the gallbladder.
Acalculous gallbladder disease is also called biliary kinesia which occurs due to the absence of gallstones.
Primary Sclerosing cholangitis is scarring, inflammation and damage to the bile ducts.
Gallbladder cancer spreads from the inner walls of the gallbladder to other organs.
Gallbladder polyps are harmless growths or lesions on the gallbladder.
Gangrene of the gallbladder occurs when there is improper or inadequate blood flow and the gallbladder does not function.
Abscess of the gallbladder occurs when the area has pus formation and is inflamed.
Bile duct obstruction is blockage of bile ducts due to gallstones.
Bile reflux when fluid in the liver called bile backs up into the stomach and esophagus.
Primary biliary cirrhosis occurs when small bile ducts in the liver are damaged.

Surgical options

Laparoscopic cholecystectomy In this procedure the gallbladder is removed by minimally invasive surgical techniques. The procedure is done under general anesthesia. Four small incisions are made in and around the umbilicus, which are called laparoscopic ports. Thin, long tubes or laparoscopes are inserted through these incisions which magnifies the view of the area. Surgical instruments are used to carefully separate the gallbladder from the liver and the bile duct and extract it through one of the ports.
Laparoscopic common bile duct exploration This procedure is commonly used in the treatment of choledocholithiasis and can be done percutaneously, laparoscopically or endoscopically. The approach is the same as laparoscopic cholecystectomy. Four ports are opened and a very small opening is made in the cystic duct where the gallbladder connects to the bile duct. Cholangiography is performed with the insertion of a thin tube. A balloon or a tiny basket is used to retrieve the stones from the duct.

 

Pancreatic Surgery

Pancreaticoduodenectomy (Whipple Procedure)

Pancreaticoduodenectomy is also called Whipple or Kausch-Whipple procedure. This procedure is performed for cancer of the pancreatic head, tumors of the common bile duct, duodenal papilla and ampulla. The procedure involves surgical removal of head of the pancreas, part of the duodenum, the gallbladder, pylorus which is a portion of the stomach and the lymph nodes located near the head of the pancreas. The end of a patient’s bile duct and the remaining pancreas are then connected to the small bowel to ensure flow of bile and enzymes into the intestines.

Distal Pancreatectomy

Indicated for tumors in the body and tail of the pancreas, a distal pancreatectomy involves the removal of neoplasms either laparoscopically or with open surgery. With both laparoscopic and open distal pancreatectomy procedures, surgeons attempt to preserve the spleen. Distal pancreatectomy attempts to remove the bottom half of the pancreas due to the presence of a tumor in the tail of the pancreas. Once removed the edge of the pancreas is sutured to avoid leakage of pancreatic juices. There are at least three different techniques for distal pancreatectomy which are open distal pancreatectomy and splenectomy, spleen preserving distal pancreatectomy and laparoscopic distal pancreatectomy.

  • Open distal pancreatectomy and splenectomyThe blood supply of the spleen is closely associated with the pancreas. Open distal pancreatectomy and splenectomy involves complete removal of the spleen along with the tail of the pancreas.
  • Spleen preserving distal pancreatectomyThe blood vessels in the spleen are responsible for supplying blood to the pancreas. In an attempt to preserve this process, the blood vessels are carefully separated from the pancreas and the tail of the pancreas is then removed.
  • Laparoscopuc distal pancreatectomyThis procedure is recommended for people suffering from pseudocysts or chronic pancreatitis, islet cell tumors of the pancreas or cystic tumors in the pancreas. A laparoscopic hand access device is utilized with an incision of about just 2.5 inches. The specialty of the device enables the surgeon to insert their hand into the abdomen during the surgery.

Drainage Procedures

With chronic pancreatitis, a dilated pancreatic duct usually reflects obstruction. Quite often these patients present with stones in the pancreas. In chronic pancreatitis, there is progressive pancreatic fibrosis and subsequent loss of exocrine and endocrine functions. Surgical intervention is warranted for patients with intractable pain that does not respond to non-surgical therapy. Otherwise considered benign, chronic pancreatitis can affect the quality of life in an individual causing significant distress.

Procedures to improve ductal drainage include:

Longitudinal Pancreaticojejunostomy (Puestow Procedure)
A longitudinal incision is made in the pancreas. The pancreatic duct is opened from the tail to the head of the pancreas and attached to the small bowel. The duct and the pancreas are then sewn together to the pancreatic duct to allow drainage.

Distal Pancreaticojejunostomy (Du Val Procedure)
The pancreas is divided transversely at the neck, and the body and tail are drained via attachment to the small bowel. A termino-lateral Pancreaticojejunostomy will enable resection of the pancreatic tail and retrograde drainage of the pancreatic duct. The pancreatic duct is then decompressed.

Sphincteroplasty
When endoscopic sphincterotomy is unsuccessful, surgical transduodenal sphincteroplasty may be required of the minor or major papilla. It is an open surgery under general anesthesia.

Small Bowel Surgery

Small intestine

Surgery on the small intestine is one of the most frequently done procedures in our surgical practice which include Small Bowel Obstruction Surgery and Small Bowel Resection Surgery. Where most of the conditions could be treated with medicines small bowel obstruction and adenocarcinoma of the small bowel essentially require surgery.

Some of the conditions that cause disruptions in the small bowel and require surgical intervention are outlined below.

Tuberculosis of the intestine:

Small intestine is one of the common sites of tuberculosis in India and even associated with HIV. The small intestinal involvement is in the region of distal small bowel and proximal colon called ‘ileo-caecal tuberculosis’ This condition usually presents with progressive obstruction to the lumen of the bowel leading on to constipation and diarrhea. This requires surgical treatment in the form of limited resection of the ileo-caecal region. A tuberculous intestine is usually an emergency procedure.

Small bowel perforation:

Typhoid ulcers leading onto perforation and peritonitis requiring emergency laparotomy and closure of perforation is not uncommon in our practice. This is an absolute emergency and should be tackled right away without delay. The surgery aims at correcting the anatomical problem and removes any foreign material that might have been lodged in the peritoneal cavity. The distended bowel is decompressed through a nasogastric tube.

Bleeding from the small bowel:

Small bowel bleeding is uncommon and is difficult to diagnose. It occurs predominantly due to abnormal blood vessels or arteriovenous malformations in the wall of the bowel. Often labeled as ‘obscure GI bleeding’ it can be slow chronic ooze or massive bleeding all of a sudden. This entity will require a variety of investigations like capsule endoscopy; enteroscopy and a nuclear scan to exactly localize the site of bleed which then has to be removed surgically.  If the cause is identified as AVMs, then they are cauterized with a small amount of electric current is passed through the endoscope.

Crohn’s Disease: Crohn’s disease is yet another condition of the small intestine seen more often these days than before, usually seen in young individuals with chronic diarrhea and weight loss. There are specific investigations available now to diagnose this condition with accuracy. Most of these patients will require long-term medical treatment. Some of them develop bowel obstruction, internal fistulae requiring repeated operations. The operative options for Crohn’s disease include internal bypass, external bypass, resection of the small bowel, anastomotic technique, laparoscopy and laparoscopic assisted procedure and strictureplasty.

Tumor:

Tumors of the small bowel are either adenocarcinoma or lymphoma presenting with bleeding and or obstruction. These need to be excised with a wide margin. Gastro-intestinal stromal tumors are seen quite often in the small intestine requiring excising a segment of the involved bowel. Small bowel adenocarcinomas are essentially treated with resection – removal of the affected portion and rejoining of the small bowel, chemotherapy and radiotherapy.

Gangrene:

A gangrenous bowel can be a life-threatening condition. This usually affects people above the age of 50. Sudden occlusion of the blood supply to the small intestine leading on to gangrene of the small bowel causes severe abdominal pain and distension. Emergency surgical resection of the gangrenous tissue is conducted along with antibiotic therapy. A new opening in the abdomen is created to allow waste to empty into a bag outside the body.

Small bowel obstruction:

Incarceration in a hernia and trauma to the intestine are some of the other common conditions requiring surgery on the small intestine. Bowel obstruction can be functional or mechanical. The repair is conducted under general anesthesia. The area of blockage is identified and unblocked and damaged parts of the bowel are removed. The healthy ends are then reconnected and stapled.

Colorectal Surgery

Colorectal surgery is required for disorders of the colon, rectum and anus. Common surgical treatments include colectomy, polypectomy, ileo/colostomy, strictureplasty, anoplasty, and hemorrhoidectomy. A new surgical method called Compression Anastomotic Ring-locking Procedure (CARP) is also a preferred choice.

Surgery for Familial polyposis coli:

Familial polyposis coli or familial adenomatous polyposis is an uncommon hereditary disease of the colon presenting with multiple polyps all over the colon. This condition has a high malignant potential hence will require complete removal of the colon and rectum. Bowel continuity is restored by performing an ileo-anal pouch. This surgery is prophylactic and is performed when the polyps are diagnosed usually in teenagers. There are four types of surgical options total abdominal colectomy with ileo-rectal anastomosis, total proctocolectomy with end ileostomy, total proctocolectomy with ileal pouch anal anastomosis and total proctocolectomy with continent ileostomy.

Surgery for ulcerative colitis:

Ulcerative colitis is a provocative sickness of the expansive gut, which can shift in seriousness. It typically begins from the rectum and rises towards the caecum. Most patients in India have a milder type of ulcerative colitis limited to the left colon and subsiding with oral medicine. Some of these patients present to the crisis ward with serious indications obliging hospitalization and now and again surgery for conditions like ‘poisonous megacolon’ ,gigantic lower GI draining and so forth. Surgery will include complete colectomy with ileostomy. Elective surgery for broad ulcerartive colitis or pancolitis or malignancy in a setting of ulcerative colitis will incorporate evacuation of the whole colon and rectum called ” complete procto-colectomy” and the typical congruity is restored by making an ‘ileo-butt-centric pocket’. This methodology by and large obliges making of Brooke ileostomy or landmass ileostom.

Surgery for diverticulitis:

Diverticulitis is a condition usually seen in the old where areas of weakness develop in the sigmoid and ascending colon resulting in localized ballooning of colonic mucosa called diverticulosis. Infection and inflammation of these diverticuli result in diverticulitis. This condition might require surgery if it presents with colonic obstruction, colo-vesical fistula or uncontrollable bleeding. Surgery includes partial colectomy and anastomosis. Surgery of diverticulitis is recommended if the patient faces repeated attacks of diverticulitis, an abnormal fistula formed between the colon and the adjacent organ and people who have an impaired immune system susceptible to repeated attacks of diverticulitis.

Surgery for Cancer of Colon and rectum:

One of the commonest diseases of the colon and rectum, cancer can affect any part of the large bowel. Surgical removal of the cancer is the primary treatment modality. Rectal cancers will require complete removal of the rectal apparatus with a permanent end colostomy. In some of the rectal cancers the anal sphincter mechanism can be preserved by using surgical staplers. Cancers of the colon will require removal of a part of the colon called right or left hemi-colectomy. Early stage rectal cancers use a local resection or transanal resection. Rectal tumors can also be resected using the APPEAR technique – Anterior Perineal PlanE for Ultra-low Anterior Resection. Other surgical treatments for rectal cancer include transanal endoscopic mircrosurgery and total mesorectal excision.

Stapled Hemorrhoidectomy

What are hemorrhoids?

Hemorrhoids are defined as an abnormally enlarged vein, mainly due to persistent increase in venous pressure, occurring within or just outside the anal sphincter of the rectum. The anal canal is the last four centimeters through which stool passes as it goes from the rectum to the outside world. The anus is the opening of the anal canal to the outside world.

Although most people think hemorrhoids are abnormal, they are present in everyone. It is only when the hemorrhoidal cushions enlarge that hemorrhoids can cause problems and be considered abnormal or a disease.

Prevalence of hemorrhoids

Although hemorrhoids occur in everyone, they become large and cause problems in only 4% of the general population. Hemorrhoids that cause problems are found equally in men and women, and their prevalence peaks between 45 and 65 years of age.

What is stapled hemorrhoidectomy?

Stapled hemorrhoidectomy is surgical technique for treating hemorrhoids, and is the treatment of choice for third-degree hemorrhoids (hemorrhoids that protrude with straining and can be seen on physical exam outside the anal verge. Persistent or intermittent manual reduction is necessary). Stapled hemorrhoidectomy is a misnomer since the surgery does not remove the hemorrhoids but, rather, the abnormally lax and expanded hemorrhoidal supporting tissue that has allowed the hemorrhoids to prolapse downward.

For stapled hemorrhoidectomy, a circular, hollow tube is inserted into the anal canal. Through this tube, a suture (a long thread) is placed, actually woven, circumferentially within the anal canal above the internal hemorrhoids. The ends of the suture are brought out of the anus through the hollow tube. The stapler (a disposable instrument with a circular stapling device at the end) is placed through the first hollow tube and the ends of the suture are pulled. Pulling the suture pulls the expanded hemorrhoidal supporting tissue into the jaws of the stapler. The hemorrhoidal cushions are pulled back up into their normal position within the anal canal. The stapler then is fired. When it fires, the stapler cuts off the circumferential ring of expanded hemorrhoidal tissue trapped within the stapler and at the same time staples together the upper and lower edges of the cut tissue.

Who is a good candidate for stapled hemorrhoidectomy?

Stapled hemorrhoidectomy, although it can be used to treat second degree hemorrhoids (hemorrhoids that extend outside the anus after a bowel movement or straining, but return inside by themselves), usually is reserved for higher grades of hemorrhoids – third and fourth degree. Third degree hemorrhoids can be pushed back into the anus with a finger after a bowel movement. Fourth degree hemorrhoids are always outside. If in addition to internal hemorrhoids there are small external hemorrhoids that are causing a problem, the external hemorrhoids may become less problematic after the stapled hemorrhoidectomy. Another alternative is to do a stapled hemorrhoidectomy and a simple excision of the external hemorrhoids. If the external hemorrhoids are large, a standard surgical hemorrhoidectomy may need to be done to remove both the internal and external hemorrhoids.

Pictures of stapled hemorrhoidectomy procedure

Picture of Internal Hemorrhoids in Anal Canal

Picture of Hollow Tube Inserted into the Anal Canal and Pushing up the Hemorrhoids

Picture of Suturing the Anal Canal through the Hollow Tube

Picture of Bringing Expanded Hemorrhoidal Supporting Tissue into the Hollow Tube by pulling On Suture

Picture of Hemorrhoids Pulled Back Above Anal Canal after Stapling and Removal of Hemorrhoidal Supporting Tissue

Varicose Veins

Varicose (VAR-i-kos) veins are swollen, twisted veins that you can see just under the surface of the skin. These veins usually occur in the legs; however, they can also form in other parts of your body. Varicose veins are a common condition, and usually cause few signs or symptoms. In some cases, varicose veins may cause complications, such as mild to moderate pain, blood clots, or skin ulcers.

Veins are blood vessels that carry blood from your body’s tissues to your heart. The heart pumps the blood to your lungs to pick up oxygen. The oxygen-rich blood is then pumped out to your body through your arteries. From your arteries, the blood flows through tiny blood vessels called capillaries, where it gives up its oxygen to the body’s tissues. Your blood then returns to your heart through your veins to pick up more oxygen.

Veins have one-way valves that help keep blood flowing toward your heart. If your valves are weak or damaged, blood can back up and pool in your veins. This causes the veins to swell, which can lead to varicose veins. A number of factors may increase your risk for varicose veins, including family history, age, gender, pregnancy, overweight or obesity, and lack of movement.
Varicose veins are treated with lifestyle changes and medical procedures. The goals of treatment are to relieve symptoms, prevent complications, and improve appearance.

Outlook

Varicose veins don’t usually cause medical problems. If your varicose veins cause any signs and symptoms, your doctor may suggest simply making lifestyle changes.

In some cases, varicose veins can cause complications, such as pain, blood clots, or skin ulcers. If your condition is more severe, your doctor may recommend one or more medical procedures. Some people choose to have these procedures to improve the appearance of their varicose veins or to relieve pain.

A number of treatments are available for varicose veins that are quick and easy, and don’t require a long recovery time.

Vein Problems Related to Varicose Veins

A number of vein problems are related to varicose veins, such as telangiectasias (tel-AN-juh-ek-TA-ze-uhs), spider veins, varicoceles (VAR-i-ko-seals), and other vein problems.

Telangiectasias

Telangiectasias are small clusters of blood vessels. They’re usually found on the upper body, including the face.

These blood vessels appear red. They may form during pregnancy and often are found in people who have certain genetic disorders, viral infections, or other medical conditions, such as liver disease.

Because telangiectasias can be a sign of a more serious condition, see your doctor if you think you have them.
Spider Veins

Spider veins are a smaller version of varicose veins and a less serious type of telangiectasias. Spider veins involve the capillaries, the smallest blood vessels in the body.

Spider veins often show up on the legs and face. They usually look like a spider web or tree branch and can be red or blue. They usually aren’t a medical concern.

Varicoceles

Varicoceles are varicose veins in the scrotum (the skin over the testicles). Varicoceles may be linked to male infertility. If you think you have varicoceles, see your doctor.

Other Related Vein Problems

Other types of varicose veins include venous lakes, reticular veins, and hemorrhoids. Venous lakes are varicose veins that appear on the face and neck.
Reticular veins are flat blue veins often seen behind the knees. Hemorrhoids are varicose veins in and around the anus.

Causes

Weak or damaged valves in the veins can cause varicose veins. After your arteries deliver oxygen-rich blood to your body, your veins return the blood to your heart. The veins in your legs must work against gravity to do this.

One-way valves inside the veins open to let blood flow through and then shut to keep blood from flowing backward. If the valves are weak or damaged, blood can back up and pool in your veins. This causes the veins to swell.

Weak valves may be due to weak vein walls. When the walls of the veins are weak, they lose their normal elasticity and become like an overstretched rubber band. This makes the walls of the veins longer and wider, and causes the flaps of the valves to separate.

When the valve flaps separate, blood can flow backward through the valves. The backflow of blood fills the veins and stretches the walls even more. As a result, the veins get bigger, swell, and often get twisted as they try to squeeze into their normal space. These are varicose veins.

The illustration shows how a varicose vein forms in a leg. Figure A shows a normal vein with a working valve and normal blood flow. Figure B shows a varicose vein with a deformed valve, abnormal blood flow, and thin, stretched walls. The middle image shows where varicose veins might appear in a leg.

You may be at higher risk for weak vein walls due to increasing age or a family history of varicose veins. You may also be at higher risk if you have increased pressure in your veins due to overweight or obesity, or pregnancy.

Risk Factors

A number of factors may increase your risk for varicose veins, including family history, age, gender, pregnancy, overweight or obesity, and lack of movement.
Family History

Having family members who have varicose veins may raise your risk for the condition. About half of all people who have varicose veins have a family history of them.

Age

Getting older may put you at higher risk for varicose veins. The normal wear and tear of aging may cause the valves in your veins to weaken and not work as well.

Gender

Women tend to get varicose veins more often than men. Hormonal changes that occur during puberty, pregnancy, menopause, or with the use of birth control pills may raise a woman’s chances of getting varicose veins.

Pregnancy

During pregnancy, the growing fetus puts pressure on the veins in the legs. Varicose veins that occur during pregnancy usually get better within 3 to 12 months of delivery.

Overweight or Obesity

Being overweight or obese can put extra pressure on your veins. This can lead to varicose veins.

Lack of Movement

Standing or sitting for a long time, especially with your legs bent or crossed, may raise your risk for varicose veins. This is because staying in one position for a long time may force your veins to work harder to pump blood to your heart.

Signs and Symptoms

The signs and symptoms of varicose veins include:

  • Large veins that you can see on your skin.
  • Mild swelling of your ankles and feet.
  • Painful, achy, or “heavy” legs.
  • Throbbing or cramping in your legs.
  • Itchy legs, especially on the lower leg and ankle. This is sometimes incorrectly diagnosed as dry skin.
  • Discolored skin in the area around the varicose vein.

Signs of telangiectasias are red clusters of veins that you can see on your skin. They’re usually found on the upper body, including the face. Signs of spider veins are red or blue veins in a web pattern that often show up on the legs and face.

See your doctor if you have these signs and symptoms. They also may be signs of other, sometimes more serious conditions.

Complications

Sometimes varicose veins can lead to dermatitis (der-ma-TI-tis), an itchy rash. If you have varicose veins in your legs, dermatitis may affect your lower leg or ankle. Dermatitis can cause bleeding or skin ulcers if the skin is scratched or irritated.

Varicose veins may also lead to a condition called superficial thrombophlebitis (THROM-bo-fleh-BI-tis). Thrombophlebitis is a blood clot in a vein.

Superficial thrombophlebitis means that the blood clot occurs in a vein close to the surface of the skin. This type of blood clot may cause pain and other problems in the affected area.

Diagnosis

Doctors often diagnose varicose veins based on a physical exam alone. Sometimes tests or procedures are done to find out the extent of the problem and to rule out other disorders.

Specialists Involved

If you have varicose veins, you may see a vascular medicine specialist or vascular surgeon. These are doctors who specialize in blood vessel conditions. You also may see a dermatologist. This is a doctor who specializes in skin conditions.

Physical Exam

To check for varicose veins in your legs, your doctor will look at your legs while you’re standing or sitting with your legs dangling. He or she may ask you about your signs and symptoms, including any pain you’re having.

Diagnostic Tests and Procedures

Doppler Ultrasound

Your doctor may recommend a Doppler ultrasound to check blood flow in your veins and to look for blood clots. A Doppler ultrasound uses sound waves to create pictures of structures in your body.

During this test, a handheld device will be placed on your body and passed back and forth over the affected area. A computer will convert the sound waves into a picture of the blood flow in your arteries and veins.

Angiogram

Although rare, your doctor may order an angiogram to get a more detailed look at the blood flow through your blood vessels. For this procedure, dye is injected into your veins. The dye outlines your veins on x-ray images.

An angiogram can help your doctor confirm whether you have varicose veins or another problem.

Treatment Overview

Varicose veins are treated with lifestyle changes and medical procedures. The goals of treatment are to relieve symptoms, prevent complications, and improve appearance.

If your varicose veins cause any minor symptoms, your doctor may suggest simply making lifestyle changes. If your symptoms are more severe, your doctor may recommend one or more medical procedures. For example, you may need a medical procedure if you have significant pain, blood clots, or skin disorders as a result of your varicose veins.

Some people who have varicose veins choose to have procedures to improve the appearance of their varicose veins.

Although treatment can help existing varicose veins, it can’t keep new varicose veins from forming.

Lifestyle Changes

Lifestyle changes are often the first treatment for varicose veins. These changes can prevent varicose veins from getting worse, reduce pain, and delay other varicose veins from forming. Lifestyle changes include the following:

Avoid standing or sitting for long periods without taking a break. When sitting, avoid crossing your legs. Raise your legs when sitting, resting, or sleeping.

When you can, raise your legs above the level of your heart.

Do physical activities to get your legs moving and improve muscle tone. This helps blood move through your veins.

If you’re overweight or obese, lose weight. This will improve blood flow and ease the pressure on your veins.

  • Avoid wearing tight clothes, especially those that are tight around your waist, groin (upper thighs), and legs. Tight clothes can make varicose veins worse.
  • Avoid wearing high heels for long periods. Lower heeled shoes can help tone your calf muscles. Toned muscles help blood move through the veins.
  • Your doctor may recommend compression stockings. These stockings create gentle pressure up the leg. This pressure keeps blood from pooling and decreases swelling in the legs.

There are three types of compression stockings. One type is support pantyhose – these offer the least amount of pressure. A second type is over-the-counter compression hose, which give a little more pressure than support pantyhose.

Over-the-counter compression hose are sold in medical supply stores and pharmacies.

Prescription-strength compression hose are the third type of compression stockings. These stockings offer the greatest amount of pressure, and are also sold in medical supply stores and pharmacies. However, you will need to be fitted for them in the store by a specially trained person.

Procedures & Surgical Interventions

Medical procedures are done either to remove varicose veins or to close them. Removing or closing varicose veins usually doesn’t cause problems with blood flow because the blood starts moving through other veins.

You may be treated with one or more of the procedures listed below. Common side effects right after most of these procedures include bruising, swelling, skin discoloration, and slight pain.

The side effects are most severe with vein stripping and ligation (li-GA-shun). Although rare, this procedure can cause severe pain, infection, blood clots, and scarring.

Sclerotherapy

Sclerotherapy (SKLER-o-ther-a-pe) uses a liquid chemical to close off a varicose vein. The chemical is injected into the vein to cause irritation and scarring inside the vein. The irritation and scarring cause the vein to close off, and it fades away.

This procedure is often used to treat smaller varicose veins and spider veins. It can be done in your doctor’s office, while you stand. You may need several treatments to completely close off a vein.
Treatments are typically done every 4 to 6 weeks. Following treatments, your legs will be wrapped in elastic bandaging to help healing and decrease swelling.

Microsclerotherapy

Microsclerotherapy (MI-kro-SKLER-o-ther-a-pe) is used to treat spider veins and other very small varicose veins. A small amount of liquid chemical is injected into a vein using a very fine needle. The chemical scars the inner lining of the vein, causing it to close off.

Laser Surgery

This procedure applies light energy from a laser onto a varicose vein. The laser light makes the vein fade away. Laser surgery is mostly used to treat smaller varicose veins. No cutting or injection of chemicals is involved.

Endovenous Ablation Therapy

Endovenous ablation (ab-LA-shun) therapy uses lasers or radiowaves to create heat to close off a varicose vein. Your doctor makes a tiny cut in your skin near the varicose vein. He or she then inserts a small tube called a catheter into the vein. A device at the tip of the tube heats up the inside of the vein and closes it off.

You will be awake during this procedure, but your doctor will numb the area around the vein. You can usually go home the same day as the procedure.
Endoscopic Vein Surgery

For endoscopic (en-do-SKOP-ik) vein surgery, your doctor will make a small cut in your skin near a varicose vein. He or she then uses a tiny camera at the end of a thin tube to move through the vein. A surgical device at the end of the camera is used to close the vein. Endoscopic vein surgery is usually only used in severe cases when varicose veins are causing skin ulcers. After the procedure, you can usually return to your normal activities within a few weeks.

Ambulatory Phlebectomy

For ambulatory phlebectomy (fle-BEK-to-me), your doctor will make small cuts in your skin to remove small varicose veins. This procedure is usually done to remove the varicose veins closest to the surface of your skin. You will be awake during the procedure, but your doctor will numb the area around the vein. Usually, you can go home the same day that the procedure is done.

Vein Stripping and Ligation

Vein stripping and ligation is typically only performed for severe cases of varicose veins. The procedure involves tying shut and removing the veins through small cuts in your skin. You will be given medicine to temporarily put you to sleep so you don’t feel any pain during the procedure. Vein stripping and ligation is usually done as an outpatient procedure. The recovery time from the procedure is about 1 to 4 weeks.

Limiting the Effects of Varicose Veins

You can’t prevent varicose veins from forming. However, you can prevent the ones you have from getting worse. You can also take steps to delay other varicose veins from forming:

  • Avoid standing or sitting for long periods without taking a break.
    When sitting, avoid crossing your legs. Raise your legs when sitting, resting, or sleeping. When you can, raise your legs above the level of your heart.
  • Do physical activities to get your legs moving and improve muscle tone. This helps blood move through your veins.
  • If you’re overweight or obese, lose weight. This will improve blood flow and ease the pressure on your veins.
  • Avoid wearing tight clothes, especially those that are tight around your waist, groin (upper thighs), and legs. Tight clothes can make varicose veins worse.
  • Avoid wearing high heels for long periods. Lower heeled shoes can help tone your calf muscles. Toned muscles help blood move through the veins.
  • Wear compression stockings if your doctor advises you to. These stockings create gentle pressure up the leg. This pressure keeps blood from pooling in the veins and decreases swelling in the legs.