Revolutionizing Varicose Vein Treatment: Trendelenburg Operation vs Radiofrequency Ablation in Saphenofemoral Incompetence

Revolutionizing Varicose Vein Treatment: Trendelenburg Operation vs Radiofrequency Ablation in Saphenofemoral Incompetence | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Revolutionizing Varicose Vein Treatment: Trendelenburg Operation vs Radiofrequency Ablation in Saphenofemoral Incompetence Anjali Agarwal, Steffi Dcruz, Badareesh L. This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6371112/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract INTRODUCTION: Varicose veins are dilated; tortuous veins present in lower limbs. Its prevalence increases with age, affecting quality of life. Chronic venous insufficiency is caused due to venous valve incompetence. It can be congenital, primary or secondary. MATERIAL AND METHODS: This prospective observational study included symptomatic patients who underwent Trendelenburg operation or Radiofrequency ablation for lower limb varicose veins from November 2022 to January 2024. Venous Doppler was used to diagnose saphenofemoral incompetence, and CEAP classification was used to measure disease severity. Postoperative pain, complications, return to routine activity and cost were analyzed. Patients with a history of deep vein thrombosis were omitted. RESULTS : The final analysis included 84 patients. 42 patients in each group. Patients who underwent Radiofrequency ablation had less immediate postoperative pain, lesser hospital stay and earlier return to routine activity. There was a significantly greater reduction in venous clinical severity score in patients who underwent Trendelenburg operation. CONCLUSION: Due to earlier return to routine activity and less immediate postoperative pain, endovenous procedures can be performed as daycare procedures. Trendelenburg operation venous stripping Radiofrequency ablation varicose veins chronic venous insufficiency INTRODUCTION Varicose veins are dilated, tortuous veins with at least 3mm diameter. It is more prevalent in females than males (1). The lower limb consists of a superficial, deep, and perforator connecting system. Patients can be asymptomatic or may present with oedema, pain, discomfort or complications associated with varicose veins. Superficial system incompetence is responsible for most varicosities in the lower limb. Patients seek treatment for varicose veins for the following reasons- to alleviate the symptoms and prevent complications or cosmesis. It can be managed conservatively, or intervention may be required based on clinical presentations and patient choice (2). Conventionally, GSV/ SSV incompetence was treated by SFJ or SPJ ligation, followed by stripping the vein. Over the past decade, recommendations for treating symptomatic varicose veins have significantly shifted with the advent of minimally invasive endovascular techniques (3). This approach may reduce early postoperative complications, speed up recovery, and allow for a quicker return to normal activities. MATERIALS AND METHODS Study design: Prospective, single-centre, observational study conducted in the Department of General Surgery, Kasturba Hospital, Manipal. Our study aimed to evaluate the difference between the treatment efficacy of radiofrequency ablation over Trendelenburg operation. The objectives were to measure postoperative pain on POD-0 at 6 hours, POD-1 and POD-2, to assess the mean duration of hospital stay, to measure the VCSS score at 2 weeks, and to determine the mean time to return to routine activity. Patients with symptomatic varicose veins above 18 years with Clinical Etiologic Anatomic Pathophysiologic (CEAP) class: C2-6EpAsPr and GSV incompetence were included after obtaining consent. Patients with a history of deep vein thrombosis or acute thrombophlebitis or peripheral arterial disease were excluded from the study. Statistical analysis- Categorical data was summarized by frequency and percentages. Quantitative data was summarized in the mean. Categorical data was compared between the groups using the Chi-square test. Quantitative data was compared using paired and unpaired ‘t’ tests. RESULTS A total of 84 patients with Great saphenous vein reflux were included in the study. 42 patients were treated each with Trendelenburg operation and radiofrequency ablation (RFA). No differences were noted between the two groups concerning patient age, gender or postoperative complications, as summarized in Table 1. Immediate postoperative pain was significantly less for the RFA group, as also seen in the case of returning to routine activity and hospital stay. Venous clinical severity score was reduced significantly following both procedures. The average duration of hospital stay in the case of RFA was 4.33 days, whereas in patients undergoing the Trendelenburg procedure, it was 6.31 days. Duration of hospital stay was significantly lower for the RFA group. The cost of treatment was higher for RFA, costing an average of 77088.07 rupees, whereas the average cost for the Trendelenburg operation was 41234.64 rupees, as summarized in Table 1. TABLE 1- Variables compared between RFA and Trendelenburg surgery TOTAL (84) RFA (n=42) TRENDELENBURG OPERATION (n=42) P VALUE Gender , n(%) Male Female 75 (89.2) 9 (10.7) 35 (83.3) 7 (16.7) 40 (95.2) 2 (4.8) 0.158 Age , years Mean Minimum-maximum 19-73 45.81 19-73 46.05 22-71 0.931 Postoperative score : mean (minimum-maximum) POD-0 at 6 hours POD-1 POD-2 0-10 0-10 0-10 1.36 (0-4) 0.86 (0-3) 0.29 (0-2) 3.79 (0-10) 3.31 (0-8) 2 (0-7) <0.001 Duration of hospital stay (days) Mean Minimum-maximum 3-12 4.33 3-6 6.31 4-12 <0.001 Venous clinical severity score : mean (minimum-maximum) Preoperative scores Postoperative scores 0-30 0-30 5.21 (1-13) 4.19 (0-9) 6.62 (3-14) 4.38 (2-9) 0.019 Time to return to routine activity , n(%) POD-0 at 6 hours POD-1 POD-2 POD-3 23 (27.3) 41 (48.8) 16 (19.0) 4 (4.7) 20 (47.6) 20 (47.6) 2 (4.8) 0 (0) 3 (7.1) 21 (50) 14 (33.3) 4 (9.5) <0.001 Complication frequency , n(%) Preoperative complications Postoperative complications Infection Hematoma Ecchymosis Ulceration 0 (0) 13 (15.47) 5 (5.95) 3 (3.57) 2 (2.38) 3 (3.57) 0 (0) 5 (11.90) 2 (4.76) 0 (0) 2 (4.76) 1 (2.38) 0 (0) 8 (19.04) 3 (7.14) 3 (7.14) 0 (0) 2 (4.76) 0.533 Cost of treatment: mean 77088.07 41234.64 DISCUSSION The first two decades of the century have seen significant advances in the techniques that can be used to treat varicose veins. With the advent of minimally invasive techniques for treatment like radiofrequency ablation and EVLA, dependence on surgery has been declining. Studies have shown that both procedures are effective in treating varicose veins. Due to its minimally invasive nature, it has gained popularity amongst patients. In addition to being minimally invasive, patients experience less immediate postoperative pain. However, further studies have also identified several disadvantages of minimally invasive procedures, as it is only feasible for non-tortuous varicosities. Our findings aligned with those of previous studies, as both groups demonstrated comparable outcomes concerning postoperative pain, length of hospital stay, time to return to routine activity, cost and reduction in venous clinical severity score. Subramonia et al.(4) reported that patients undergoing RFA showed better outcomes with respect to postoperative pain and time to return to routine activity, as shown by other previous studies. Our study also confirms the findings of the previous studies. Additionally, surgical treatment is more cost-effective compared to minimally invasive procedures. According to a study conducted by Rasmussen et al.(5), the cost of treatment was higher for the RFA group, which was consistent with the findings from our study. Pain experienced postoperatively, time to return to routine activity, length of hospital stay, complications and VCSS questionnaire were commonly compared in the studies mentioned in Table 2. TABLE 2 – Comparison between our study and other studies SERIAL NO. STUDY COMPLICATIONS LENGTH OF HOSPITAL STAY (days) VCSS QUESTIONNAIRE PAIN SCORES TIME TO RETURN TO ROUTINE ACTIVITY COST 1. Present study No intraoperative complications. Minor postoperative complications in both the groups, less in RFA group (11.90%) compared to Trendelenburg operation (19.04%). No statistically significant difference(p=0.546) The mean duration of hospital stay is significantly lower in the RFA group (p <0.001) VCSS improved significantly from preoperative to postoperative in both groups (p<0.0001) However, the Trendelenburg procedure have a significantly greater reduction (p=0.001) Patients in the RFA group reported significantly less postoperative pain than those in the Trendelenburg group (p<0.001) Time for resumption of routine activity was shorter in the group treated with RFA than with Trendelenburg procedure (p<0.01) Procedure cost was higher in RFA group. 2. Sincos, Baptista et al Brazil, New York 2019 (6) The incidence of complications was similar between the groups Length of hospital stay was significantly longer for the S&T Group (1.48±1.67) than for the RFA Group (0.69±0.47). R-VCSS significantly improved (p<0.001) between pre- and postoperative evaluations for all patients, but there was no difference in R-VCSS (p=0.636) between the RFA and S&T Groups - - - 3. Rasmussen, Lawaetz et al Denmark 2011 (5) Complications were mostly minor - The mean scores improved significantly after the procedure in both groups at one month, with no significant difference between them (p< 0·001) Patients in the RFA group reported significantly less postoperative pain than those in the stripping group (p< 0·001). The time to resumption of normal activities was shorter in the group treated with RFA then in the stripping group (p< 0·001) Procedure-related costs were high in the RFA group because of the higher cost of the catheter. When the cost of lost work was included in the total costs, stripping was the more expensive procedure 4. Subramonia, Lees et al Mansfield, Newcastle United Kingdom 2010 (4) A significantly higher rate of cutaneous sensory abnormalities were observed after conventional surgery (p=0.003) - - Postoperative pain and analgesic requirements were considerably less following RFA in first week (p=0.001) Patients returned to their full level of normal household activities more quickly following RFA than after conventional surgery (p< 0·001) - 5. Sandhya, Mohil et al New Delhi, Bangalore India 2020 (7) RFA group had a significantly lower complication rate (p=0.001). - The mean score in RFA decreased. However stripping, group showed an initial rise in score to day 7; by day 30, this difference narrowed. Mean score of stripping group(4.19) was higher than that for RFA group (3.6), this was statistically not significant (p= 0.148) - - - CONCLUSION Our study shows that the short-term safety and efficacy of endovenous ablation (Radiofrequency ablation) and Trendelenburg operation are similar in treating varicose veins. Patients undergoing Radiofrequency ablation and Trendelenburg operation have similar decreases in postoperative venous clinical severity scores. However, these patients experience less immediate postoperative pain and have to spend less time hospitalized during recovery. Endovenous procedures can, therefore, be performed as a daycare procedure, enabling a rapid return to normal activity. Abbreviations GSV – Great saphenous vein SSV – Short Saphenous vein SFJ – Saphenofemoral junction SPJ – Saphenopopliteal junction POD – Post operative day VCSS – venous clinical severity score RFA – radiofrequency ablation EVLA – Endo venous laser ablation Declarations Consent to Participate & Ethics Approval This study was conducted in accordance with the ethical standards of Kasturba Medical College Hospital and with the 1964 Helsinki Declaration and its later amendments. All participants in this study provided their informed consent prior to participation. They were informed about the purpose of the research, the procedures involved, their right to withdraw at any time without consequence, and the measures taken to ensure confidentiality and anonymity. The study adhered to ethical guidelines as outlined by The Institutional Ethics Committee, Kasturba Medical College & Kasturba Hospital and approval was obtained under reference number IEC2:189/2022 Also registered with the Clinical trials Registry, India with CTRI No. – CTRI/2022/11/047073 Consent for publication The authors give their fully informed consent for publication of the study and also hereby decare that the study has not been published nor has it been submitted to any other journal for publication Availability of data and materials The raw data and materials used in the study are uploaded as supplementary materials Competing Interests The authors hereby declare that they have no competing interests with regards to the study Funding No funding was sorted for in the study. Authors contributions Dr Badareesh L: Conceptualization of the research, study design, methodology development, and supervision of the research process. Dr Anjali Agarwal: Data collection and analysis, statistical analysis, interpretation of results, Literature review and drafting the manuscript. Dr Steffi Dcruz: Literature review, manuscript editing, critical revision of the manuscript for intellectual content, writing of discussion and final review of manuscript. Acknowledgments Not applicable References Raetz J, Wilson M, et al. Varicose Veins: Diagnosis and Treatment. Am Fam Physician. 2019 Jun 1;99(11):682–8. Lin F, Zhang S, et al. The Management of Varicose Veins. Int Surg. 2015 Jan;100(1):185–9. Whiteley MS. Current Best Practice in the Management of Varicose Veins. Clin Cosmet Investig Dermatol. 2022 Apr 6;15:567–83. Subramonia S, Lees T. Randomized clinical trial of radiofrequency ablation or conventional high ligation and stripping for great saphenous varicose veins. Br J Surg. 2010 Feb 5;97(3):328–36. Rasmussen LH, Lawaetz M, et al. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg. 2011 Aug;98(8):1079–87. Sincos IR, Baptista APW, et al. Prospective randomized trial comparing radiofrequency ablation and complete saphenous vein stripping in patients with mild to moderate chronic venous disease with a 3-year follow-up. Einstein. 2019;17(2):1-8. Sandhya P, Mohil R, et al. Randomised controlled study to compare radiofrequency ablation with minimally invasive ultrasound-guided non-flush ligation and stripping of great saphenous vein in the treatment of varicose veins. Ann R Coll Surg Engl. 2020 Sep;102(7):525–31. Additional Declarations No competing interests reported. Supplementary Files Data.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6371112","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":463754848,"identity":"e253cb69-4473-40bf-8665-f7d2c1c2b798","order_by":0,"name":"Anjali Agarwal","email":"","orcid":"","institution":"Kasturba Medical College, Manipal","correspondingAuthor":false,"prefix":"","firstName":"Anjali","middleName":"","lastName":"Agarwal","suffix":""},{"id":463754849,"identity":"949aa052-ebc8-489b-b3cf-58ad4b40cc4f","order_by":1,"name":"Steffi Dcruz","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIie3OsUoDMRjA8S8cZAq6Htijr5CSQUqrz3Kh4C1XKXQpKBg4uC4tXQ869BUUIXPkIC7BZ6j4AhEnoRRjry5CDkeH/CHwEfLjC0Ao9E+zMwpIHCZ3MABSAJH/PQZUmSNBVUPgDwQaEpHjZSvpboonoSaQrNaGfVzkl9cnZ8VWwWzAhYdQjblQFFj1klM2lqMp7miqwGR+gsn5m6XA7wmho7GMeBmnVKGy9pJuefr+veVA6r68cySzCu39BDRBP6RXIFk7krstwk+ovuo5ErPK4ClaymdedsxEpTpj3o8V9atQu2GyWkSP9lPe8M16/rC1t4PE+7Gm+Nectj9v46FQKBRyfQFSQV5oPxPQvgAAAABJRU5ErkJggg==","orcid":"","institution":"Kasturba Medical College, Manipal","correspondingAuthor":true,"prefix":"","firstName":"Steffi","middleName":"","lastName":"Dcruz","suffix":""},{"id":463754850,"identity":"0fc61c4e-8a94-4e11-b885-bb198c50360c","order_by":2,"name":"Badareesh L.","email":"","orcid":"","institution":"Kasturba Medical College, Manipal","correspondingAuthor":false,"prefix":"","firstName":"Badareesh","middleName":"","lastName":"L.","suffix":""}],"badges":[],"createdAt":"2025-04-03 16:53:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6371112/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6371112/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86524682,"identity":"42f04649-fd82-4257-af21-e0b171067f7e","added_by":"auto","created_at":"2025-07-11 15:38:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":589902,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6371112/v1/150098a0-5c5a-4195-a1ce-bba2a8a024b2.pdf"},{"id":83763387,"identity":"8f3d80fd-6b65-440f-863d-b967e70cc188","added_by":"auto","created_at":"2025-06-02 10:17:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":1427118,"visible":true,"origin":"","legend":"","description":"","filename":"Data.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6371112/v1/552e8630b635449969206973.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Revolutionizing Varicose Vein Treatment: Trendelenburg Operation vs Radiofrequency Ablation in Saphenofemoral Incompetence","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eVaricose veins are dilated, tortuous veins with at least 3mm diameter. It is more prevalent in females than males (1). The lower limb consists of a superficial, deep, and perforator connecting system. Patients can be asymptomatic or may present with oedema, pain, discomfort or complications associated with varicose veins. Superficial system incompetence is responsible for most varicosities in the lower limb. Patients seek treatment for varicose veins for the following reasons- to alleviate the symptoms and prevent complications or cosmesis. It can be managed conservatively, or intervention may be required based on clinical presentations and patient choice (2). Conventionally, GSV/ SSV incompetence was treated by SFJ or SPJ ligation, followed by stripping the vein. Over the past decade, recommendations for treating symptomatic varicose veins have significantly shifted with the advent of minimally invasive endovascular techniques (3). This approach may reduce early postoperative complications, speed up recovery, and allow for a quicker return to normal activities.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy design: \u003c/strong\u003eProspective, single-centre, observational study conducted in the Department of General Surgery, Kasturba Hospital, Manipal.\u003c/p\u003e\n\u003cp\u003eOur study aimed to evaluate the difference between the\u0026nbsp;treatment efficacy of radiofrequency ablation over Trendelenburg operation. The objectives were to measure postoperative pain on POD-0 at 6 hours, POD-1 and POD-2, to assess the mean duration of hospital stay, to measure the VCSS score at 2 weeks, and to determine the mean time to return to routine activity.\u003c/p\u003e\n\u003cp\u003ePatients with symptomatic varicose veins above 18 years with Clinical Etiologic Anatomic Pathophysiologic (CEAP) class: C2-6EpAsPr and GSV incompetence were included after obtaining consent. Patients with a history of deep vein thrombosis or acute thrombophlebitis or peripheral arterial disease were excluded from the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis-\u003c/strong\u003e Categorical data was summarized by frequency and percentages. Quantitative data was summarized in the mean. Categorical data was compared between the groups using the Chi-square test. Quantitative data was compared using paired and unpaired \u0026lsquo;t\u0026rsquo; tests.\u003c/p\u003e"},{"header":"RESULTS ","content":"\u003cp\u003eA total of 84 patients with Great saphenous vein reflux were included in the study. 42 patients were treated each with Trendelenburg operation and radiofrequency ablation (RFA). No differences were noted between the two groups concerning patient age, gender or postoperative complications, as summarized in Table 1.\u003c/p\u003e\n\u003cp\u003eImmediate postoperative pain was significantly less for the RFA group, as also seen in the case of returning to routine activity and hospital stay. Venous clinical severity score was reduced significantly following both procedures. The average duration of hospital stay in the case of RFA was 4.33 days, whereas in patients undergoing the Trendelenburg procedure, it was 6.31 days. Duration of hospital stay was significantly lower for the RFA group.\u003c/p\u003e\n\u003cp\u003eThe cost of treatment was higher for RFA, costing an average of 77088.07 rupees, whereas the average cost for the Trendelenburg operation was 41234.64 rupees, as summarized in Table 1.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; TABLE 1- Variables compared between RFA and Trendelenburg surgery\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"617\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTOTAL (84)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRFA (n=42)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTRENDELENBURG OPERATION (n=42)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP VALUE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e, n(%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Male\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e75 (89.2)\u003c/p\u003e\n \u003cp\u003e9 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e35 (83.3)\u003c/p\u003e\n \u003cp\u003e7 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40 (95.2)\u003c/p\u003e\n \u003cp\u003e2 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e, years\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Mean\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Minimum-maximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19-73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e45.81\u003c/p\u003e\n \u003cp\u003e19-73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e46.05\u003c/p\u003e\n \u003cp\u003e22-71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.931\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative score\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n \u003cp\u003emean (minimum-maximum)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;POD-0 at 6 hours\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;POD-1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;POD-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0-10\u003c/p\u003e\n \u003cp\u003e0-10\u003c/p\u003e\n \u003cp\u003e0-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.36 (0-4)\u003c/p\u003e\n \u003cp\u003e0.86 (0-3)\u003c/p\u003e\n \u003cp\u003e0.29 (0-2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.79 (0-10)\u003c/p\u003e\n \u003cp\u003e3.31 (0-8)\u003c/p\u003e\n \u003cp\u003e2 (0-7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of hospital stay\u003c/strong\u003e (days)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Mean\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Minimum-maximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3-12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4.33\u003c/p\u003e\n \u003cp\u003e3-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6.31\u003c/p\u003e\n \u003cp\u003e4-12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVenous clinical severity score\u003c/strong\u003e: mean (minimum-maximum)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Preoperative scores\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Postoperative scores\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0-30\u003c/p\u003e\n \u003cp\u003e0-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5.21 (1-13)\u003c/p\u003e\n \u003cp\u003e4.19 (0-9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6.62 (3-14)\u003c/p\u003e\n \u003cp\u003e4.38 (2-9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime to return to routine activity\u003c/strong\u003e, n(%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;POD-0 at 6 hours\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;POD-1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;POD-2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;POD-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23 (27.3)\u003c/p\u003e\n \u003cp\u003e41 (48.8)\u003c/p\u003e\n \u003cp\u003e16 (19.0)\u003c/p\u003e\n \u003cp\u003e4 (4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20 (47.6)\u003c/p\u003e\n \u003cp\u003e20 (47.6)\u003c/p\u003e\n \u003cp\u003e2 (4.8)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (7.1)\u003c/p\u003e\n \u003cp\u003e21 (50)\u003c/p\u003e\n \u003cp\u003e14 (33.3)\u003c/p\u003e\n \u003cp\u003e4 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplication frequency\u003c/strong\u003e, n(%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Preoperative complications\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Postoperative complications\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Infection\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Hematoma\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Ecchymosis\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Ulceration\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13 (15.47)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (5.95)\u003c/p\u003e\n \u003cp\u003e3 (3.57)\u003c/p\u003e\n \u003cp\u003e2 (2.38)\u003c/p\u003e\n \u003cp\u003e3 (3.57)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (11.90)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (4.76)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e2 (4.76)\u003c/p\u003e\n \u003cp\u003e1 (2.38)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (19.04)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (7.14)\u003c/p\u003e\n \u003cp\u003e3 (7.14)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e2 (4.76)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.533\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCost of treatment:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e77088.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e41234.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe first two decades of the century have seen significant advances in the techniques that can be used to treat varicose veins. With the advent of minimally invasive techniques for treatment like radiofrequency ablation and EVLA, dependence on surgery has been declining. Studies have shown that both procedures are effective in treating varicose veins. Due to its minimally invasive nature, it has gained popularity amongst patients. In addition to being minimally invasive, patients experience less immediate postoperative pain. However, further studies have also identified several disadvantages of minimally invasive procedures, as it is only feasible for non-tortuous varicosities.\u003c/p\u003e\n\u003cp\u003eOur findings aligned with those of previous studies, as both groups demonstrated comparable outcomes concerning postoperative pain, length of hospital stay, time to return to routine activity, cost and reduction in venous clinical severity score.\u003c/p\u003e\n\u003cp\u003eSubramonia et al.(4)\u0026nbsp;reported that patients undergoing RFA showed better outcomes with respect to postoperative pain and time to return to routine activity, as shown by other previous studies. Our study also confirms the findings of the previous studies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdditionally, surgical treatment is more cost-effective compared to minimally invasive procedures. According to a study conducted by Rasmussen et al.(5), the cost of treatment was higher for the RFA group, which was consistent with the findings from our study.\u003c/p\u003e\n\u003cp\u003ePain experienced postoperatively, time to return to routine activity, length of hospital stay, complications and VCSS questionnaire were commonly compared in the studies mentioned in Table 2.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;TABLE 2 \u0026ndash; Comparison between our study and other studies\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"692\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSERIAL NO.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSTUDY\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOMPLICATIONS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLENGTH OF HOSPITAL STAY (days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVCSS QUESTIONNAIRE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePAIN SCORES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTIME TO RETURN TO ROUTINE ACTIVITY\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOST\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e1.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003ePresent study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eNo intraoperative complications.\u003c/p\u003e\n \u003cp\u003eMinor postoperative complications in both the groups, less in RFA group (11.90%) compared to Trendelenburg operation (19.04%).\u003c/p\u003e\n \u003cp\u003eNo statistically significant difference(p=0.546)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eThe mean duration of hospital stay is significantly lower in the RFA group (p \u0026lt;0.001)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eVCSS improved significantly from preoperative to postoperative in both groups (p\u0026lt;0.0001)\u003c/p\u003e\n \u003cp\u003eHowever, the Trendelenburg procedure have a significantly greater reduction (p=0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003ePatients in the RFA group reported significantly less postoperative pain than those in the Trendelenburg group (p\u0026lt;0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eTime for resumption of routine activity was shorter in the group treated with RFA than with Trendelenburg procedure (p\u0026lt;0.01)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003eProcedure cost was higher in RFA group.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e2.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eSincos, Baptista et al\u003c/p\u003e\n \u003cp\u003eBrazil, New York\u003c/p\u003e\n \u003cp\u003e2019 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eThe incidence of complications was similar between\u003c/p\u003e\n \u003cp\u003ethe groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eLength of hospital stay was significantly longer for\u003c/p\u003e\n \u003cp\u003ethe S\u0026amp;T Group (1.48\u0026plusmn;1.67) than for the RFA Group\u003c/p\u003e\n \u003cp\u003e(0.69\u0026plusmn;0.47).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eR-VCSS significantly improved\u003c/p\u003e\n \u003cp\u003e(p\u0026lt;0.001) between pre- and postoperative evaluations\u003c/p\u003e\n \u003cp\u003efor all patients, but there was no difference\u003c/p\u003e\n \u003cp\u003ein R-VCSS (p=0.636)\u003c/p\u003e\n \u003cp\u003ebetween the RFA and S\u0026amp;T Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e3.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eRasmussen, Lawaetz et al\u003c/p\u003e\n \u003cp\u003eDenmark\u003c/p\u003e\n \u003cp\u003e2011 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eComplications were mostly minor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eThe mean scores improved significantly after the procedure\u003c/p\u003e\n \u003cp\u003ein both groups at one month, with no significant difference between them\u003c/p\u003e\n \u003cp\u003e(p\u0026lt; 0\u0026middot;001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003ePatients in the RFA group reported significantly less postoperative pain\u003c/p\u003e\n \u003cp\u003ethan those in the stripping group (p\u0026lt; 0\u0026middot;001).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eThe time to resumption of normal activities\u003c/p\u003e\n \u003cp\u003ewas shorter in the group treated with RFA\u003c/p\u003e\n \u003cp\u003ethen in the stripping group (p\u0026lt; 0\u0026middot;001)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003eProcedure-related costs were high in the\u003c/p\u003e\n \u003cp\u003eRFA group because of the higher cost of the catheter. When the cost of lost work\u003c/p\u003e\n \u003cp\u003ewas included in the total costs, stripping was the more expensive\u003c/p\u003e\n \u003cp\u003eprocedure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e4.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eSubramonia, Lees et al\u003c/p\u003e\n \u003cp\u003eMansfield, Newcastle\u003c/p\u003e\n \u003cp\u003eUnited Kingdom\u003c/p\u003e\n \u003cp\u003e2010 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eA significantly higher rate of cutaneous sensory\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eabnormalities were observed after conventional surgery (p=0.003)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003ePostoperative pain and analgesic requirements were\u003c/p\u003e\n \u003cp\u003econsiderably less following RFA in first week (p=0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003ePatients returned to their full level of normal household\u003c/p\u003e\n \u003cp\u003eactivities more quickly\u003c/p\u003e\n \u003cp\u003efollowing RFA than after conventional surgery (p\u0026lt; 0\u0026middot;001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e5.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eSandhya, Mohil et al\u003c/p\u003e\n \u003cp\u003eNew Delhi, Bangalore\u003c/p\u003e\n \u003cp\u003eIndia\u003c/p\u003e\n \u003cp\u003e2020 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eRFA group had a significantly lower complication rate (p=0.001).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eThe mean score in RFA decreased. However stripping, group showed an initial rise in score to day 7; by day 30, this difference narrowed. Mean score of stripping group(4.19) was higher than that for RFA group (3.6), this was statistically not significant (p= 0.148)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eOur study shows that the short-term safety and efficacy of endovenous ablation (Radiofrequency ablation) and Trendelenburg operation are similar in treating varicose veins. Patients undergoing Radiofrequency ablation and Trendelenburg operation have similar decreases in postoperative venous clinical severity scores. However, these patients experience less immediate postoperative pain and have to spend less time hospitalized during recovery. Endovenous procedures can, therefore, be performed as a daycare procedure, enabling a rapid return to normal activity.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eGSV \u0026ndash; Great saphenous vein\u003c/p\u003e\n\u003cp\u003eSSV \u0026ndash; Short Saphenous vein\u003c/p\u003e\n\u003cp\u003eSFJ \u0026ndash; Saphenofemoral junction\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSPJ \u0026ndash; Saphenopopliteal junction\u003c/p\u003e\n\u003cp\u003ePOD \u0026ndash; Post operative day\u003c/p\u003e\n\u003cp\u003eVCSS \u0026ndash; venous clinical severity score\u003c/p\u003e\n\u003cp\u003eRFA \u0026ndash; radiofrequency ablation\u003c/p\u003e\n\u003cp\u003eEVLA \u0026ndash; Endo venous laser ablation\u003c/p\u003e"},{"header":"Declarations","content":"\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cu\u003eConsent to Participate \u0026amp; Ethics Approval\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cu\u003e\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical standards of Kasturba Medical College Hospital and with the 1964 Helsinki Declaration and its later amendments.\u003c/p\u003e\n\u003cp\u003eAll participants in this study provided their informed consent prior to participation. They were informed about the purpose of the research, the procedures involved, their right to withdraw at any time without consequence, and the measures taken to ensure confidentiality and anonymity. The study adhered to ethical guidelines as outlined by The Institutional Ethics Committee, Kasturba Medical College \u0026amp; Kasturba Hospital and approval was obtained under reference number IEC2:189/2022\u003c/p\u003e\n\u003cp\u003eAlso registered with the Clinical trials Registry, India with CTRI No. \u0026ndash; CTRI/2022/11/047073\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cu\u003eConsent for publication\u003c/u\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe authors give their fully informed consent for publication of the study and also hereby decare that the study has not been published nor has it been submitted to any other journal for publication\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cu\u003eAvailability of data and materials\u003c/u\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe raw data and materials used in the study are uploaded as supplementary materials \u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cu\u003eCompeting Interests\u003c/u\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe authors hereby declare that they have no competing interests with regards to the study\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cu\u003eFunding\u003c/u\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eNo funding was sorted for in the study.\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cu\u003eAuthors contributions\u003c/u\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eDr Badareesh L: Conceptualization of the research, study design, methodology development, and supervision of the research process.\u003c/p\u003e\n\u003cp\u003eDr Anjali Agarwal: Data collection and analysis, statistical analysis, interpretation of results, Literature review and drafting the manuscript.\u003c/p\u003e\n\u003cp\u003eDr Steffi Dcruz: Literature review, manuscript editing, critical revision of the manuscript for intellectual content, writing of discussion and final review of manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cu\u003eAcknowledgments\u003c/u\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eRaetz J, Wilson M, et al. Varicose Veins: Diagnosis and Treatment. Am Fam Physician. 2019 Jun 1;99(11):682\u0026ndash;8.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLin F, Zhang S, et al. The Management of Varicose Veins. Int Surg. 2015 Jan;100(1):185\u0026ndash;9.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWhiteley MS. Current Best Practice in the Management of Varicose Veins. Clin Cosmet Investig Dermatol. 2022 Apr 6;15:567\u0026ndash;83.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSubramonia S, Lees T. Randomized clinical trial of radiofrequency ablation or conventional high ligation and stripping for great saphenous varicose veins. Br J Surg. 2010 Feb 5;97(3):328\u0026ndash;36.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eRasmussen LH, Lawaetz M, et al. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg. 2011 Aug;98(8):1079\u0026ndash;87.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSincos IR, Baptista APW, et al. Prospective randomized trial comparing radiofrequency ablation and complete saphenous vein stripping in patients with mild to moderate chronic venous disease with a 3-year follow-up. Einstein. 2019;17(2):1-8.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSandhya P, Mohil R, et al. Randomised controlled study to compare radiofrequency ablation with minimally invasive ultrasound-guided non-flush ligation and stripping of great saphenous vein in the treatment of varicose veins. Ann R Coll Surg Engl. 2020 Sep;102(7):525\u0026ndash;31.\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Trendelenburg operation, venous stripping, Radiofrequency ablation, varicose veins, chronic venous insufficiency","lastPublishedDoi":"10.21203/rs.3.rs-6371112/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6371112/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eINTRODUCTION: \u003c/strong\u003eVaricose veins are dilated; tortuous veins present in lower limbs. Its prevalence increases with age, affecting quality of life. Chronic venous insufficiency is caused due to venous valve incompetence. It can be congenital, primary or secondary.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMATERIAL AND METHODS: \u003c/strong\u003eThis prospective observational study included symptomatic patients who underwent Trendelenburg operation or Radiofrequency ablation for lower limb varicose veins from November 2022 to January 2024. Venous Doppler was used to diagnose saphenofemoral incompetence, and CEAP classification was used to measure disease severity. Postoperative pain, complications, return to routine activity and cost were analyzed. Patients with a history of deep vein thrombosis were omitted.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS\u003c/strong\u003e: The final analysis included 84 patients. 42 patients in each group. Patients who underwent Radiofrequency ablation had less immediate postoperative pain, lesser hospital stay and earlier return to routine activity. There was a significantly greater reduction in venous clinical severity score in patients who underwent Trendelenburg operation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONCLUSION: \u003c/strong\u003eDue to earlier return to routine activity and less immediate postoperative pain, endovenous procedures can be performed as daycare procedures.\u003c/p\u003e","manuscriptTitle":"Revolutionizing Varicose Vein Treatment: Trendelenburg Operation vs Radiofrequency Ablation in Saphenofemoral Incompetence","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-02 10:17:11","doi":"10.21203/rs.3.rs-6371112/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7edf9256-7684-4547-a101-5546dc15168e","owner":[],"postedDate":"June 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-11T15:38:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-02 10:17:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6371112","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6371112","identity":"rs-6371112","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}