Elective surgical treatment of pregnant women with primary symptomatic chronic varicose veins of the inguinal canal with short-term stay in the obstetric department

Abstract

The purpose of the work. To develop the indications for the planned surgical treatment of primary symptomatic varicose veins of the inguinal canal (PSVVIC) with a short-term hospital stay in the postoperative period (according to IAAS terminology) and evaluate its results in pregnant women. Material and methods. On the basis of the Public Facility "Regional Perinatal Center" of the Rivne Regional Council from the beginning of 2013 to February 2018 inclusively 14093 patients gave birth. 825 pregnant women (5.85%) had the primary symptomatic vein disease С2S-C4s,Ep,Ap,r,Pp (according to CEAP classification of 2002) according to the data of duplex scanning of veins the lower extremities (superficial and deep veins), veins of the pelvis, and inguinal canals. It was studied from which venous basins there is a pathological reflux in the veins of which the primary symptomatic varicose veins of the inguinal canals (PSVVIC) is formed. The isolated form of PSVVIC was diagnosed in 68 pregnant women (8.24%), in combination with varicose saphenous and / or non-saphenous veins– in 197 patients (23.88%). 48 pregnant women (18.11%) were operated in the planned order, 98% of patients in the postoperative period in 11-111 trimesters only in the conditions of obstetric hospital with a short-term stay (up to 48 hours. Study results and their discussion. Among 825 patients with SPCVD, due to duplex scanning, 68 pregnant women (8.24%) were diagnosed with PSVVIC in an isolated form (in 16 patients (23.53%) it was located within the inguinal canal, and in 52 (76.47%) – spread beyond its through external inguinal ring, forms varicose veins of the external genitalia and / or lower extremities). The combined forms of PSVVIC were noted in 197 (23.88%) patients: PSVVIC with varicose veins of the saphenous vein basin in 120 (60.91%) examined persons, with varicose saphenous and non-saphenous veins – in 77 (39.09%) examined persons. In 58 (21.89%) patients with PSVVIC the disease was bilateral, right-sided – in 96 (37.36%) pregnant women, left-sided – 111 (40.75%) patients. Indications for planned surgical intervention, surgical tactics of treatment of this pathology, depending on the form and prevalence, are formed. Among 265 pregnant women, 48 (18.11%) patients with different forms of PSVVIC agreed to carry out in the planned order surgical treatment of this pathology in the conditions of obstetrical hospital in 11-111 trimesters of pregnancy with short-term hospital stay: 21 patient (43.75%) due to ineffective conservative therapy, when the disease was clinically progressed and spread; 18 pregnant women (37.5%) for the purpose of preparing the natural birth canal for delivery by natural way with pronounced varicose veins of the external genitalia and the perineum to reduce the risks of bleeding in case of rupture of varices and narrowing the indications for surgical delivery; 9 patients (18.75%) – on their demand, to improve the cosmetic problems of the external genitalia and / or lower extremities caused by varicose veins. Operative interventions were performed in the absence of contraindications to intervention in the pregnant woman from the side of the somatic and obstetric statuses. Positive clinical results of treatment were obtained in 98% of operated pregnant women, which are confirmed by the data of duplex scanning and subjective evaluation of operated pregnant women. In all operated women negative effects of surgical intervention on the course of pregnancy, development of the fetus, childbirth and postpartum period are not marked. Conslusions. PSVVIC occurs in 8.24% of pregnant women in an isolated form, manifested by the clinic of the inguinal hernia, and varicose veins of the external genitalia, varicose veins of the lower extremities. Often, in 23.88% of the examined persons it is found in combination with varicose veins in the basin of saphenous and / or non-saphenous veins). Surgical treatment of various forms of PSVVIC was performed in 48 pregnant women (18.11%) in the planned order in 100% in the conditions of obstetric hospital with a short-term stay in the postoperative period: 21 patient (43.75%) due to ineffective conservative therapy, when the disease progressed clinically and spread; 18 pregnant women (37.5%) for the purpose of preparing the natural birth canal for delivery by natural way with pronounced varicose veins of the external genitalia and the perineum to reduce the risks of bleeding in the event of rapture of varices and indications for surgical delivery; 9 (18.75%) – on their demand, to improve the cosmetic problems of the external genitalia and / or lower extremities caused by varicose veins in the absence of contraindications to intervention in the pregnant woman from the side of the somatic and obstetric statuses. Surgical tactics: in the isolated form of PSVVIC, when varicose veins spread outside the inguinal canal from the external inguinal ring, clinically manifested by varicose veins of the external genitalia and / or lower extremities, venous conglomerates were ligated with ligatures without their excision without opening the inguinal canal; at combined PSVVIC forms with varicose veins of the external genitalia, which was formed of the branches of the great saphenous vein due to abnormal reflux in them at failure of ostial valve of saphenous veins, a bandage was performed in one session with ligatures (at least two) of the suture material, which are not biodegradable, of venous conglomerates emerging from the external inguinal ring without their excision and opening of the inguinal canal and on the trunks of the saphenous veins in the area of the fistulas ("crosses") and on their branches. All surgical interventions were performed under tumescense anesthesia in the 11-111 trimesters.