1 Jan 2016Systematic Review
Comparison of traditional surgery and laser treatment of incontinent great saphenous vein. Result of a meta-analysis
Gennaro Quarto 1Bruno Amato 2Umberto Giani 2Giacomo Benassai 3Emanuele Gallinoro 3Marco Apperti 4Ermenegildo Furino 3
Affiliations
Article Info
1 Department of Clinical Medicine and Surgery, “Federico II” University, Naples, Italy; C.I.R.F.F. (Interuniversitary Centre for Research and Education in Phlebology), University of Perugia, Perugia, Italy
2 Department of Public Health, “Federico II” University, Naples, Italy
3 Department of Clinical Medicine and Surgery, “Federico II” University, Naples, Italy
4 President of S.I.F. (Italian Society of Phlebology); C.I.R.F.F. (Interuniversitary Centre for Research and Education in Phlebology), University of Perugia, Perugia, Italy
Ann. Ital. Chir., 2016, 87(1), 61-67;
Published: 1 Jan 2016
Copyright © 2016 Annali Italiani di Chirurgia
This work is licensed under a Creative Commons Attribution 4.0 International License.
Abstract
AIM: This paper aims to compare EVLA to traditional surgery, by evaluating the incidence of recurrences. MATERIAL OF STUDY: We performed a meta-analysis to challenge both surgical and LASER treatment, using, as clinical outcome, the presence or the absence of reflux. A systematic review of literature about the treatment of varicose veins was performed, searching in the following databases: PUBMED-MEDLINE, Cochrane Library. Search terms considered were: stripping, HL/S, surgery, LASER, EVL*, varicose vein, GSV, saphenous vein. Only RCTs based at least on sixmonths follow-up were considered eligible in the study. Methodological quality of the included studies was evaluated using Cochrane Collaboration Bias Risk Assessment Tool. Effects of the dichotomous variables taken in consideration were evaluated using pooled risk-ratios with 95% C.I. Articles were evaluated initially from abstracts; eligible papers were fulltext examined. RESULTS: We have considered 2 groups, A and B. A Group: 756 legs treated with conventional surgical procedure; B Group: 755 legs treated with EVLA technique. A Group showed 175 post-procedure recurrences, while B showed 97 recurrences. The average O.R. was 1.72; minimum O.R. was of .497 while the maximum was of 8.064. DISCUSSION: The obtained OR average value is 1.72 with a 95% C.I. of 0.94-3.12, which includes the value 1, contrary to the criteria for rejection of the null hypothesis. For this reason there is not a statistically significant difference between the results obtained by the two techniques. CONCLUSIONS: The endovascular laser ablation (EVLA) does not prove to be superior in terms of recurrence, to the surgical technique. However, it remains a viable treatment option in patients with impaired great saphenous vein, reducing postoperative pain and hospital stay.
Keywords
- Laser therapy
- Meta-analysis
- Saphenous vein
- Surgery
- Venous insufficiency