Comment to: Defence’s argument for stripping without high ligation (Plaidoyer pour le stripping sans crossectomie), by Creton D. Phlébologie 2013;66:49-53.

Stripping without high ligation (HL), although commonly practiced by many centers, is still disputed. It is now assumed that HL is not necessary when GSV incontinence is not due to Junction incompetence but depends from perineal, Giacomini, perforating or lymphatic-ganglion veins. Following the traditional knowledge, leaving a long stump at the junction, like after a stripping without HL or an endovascular procedure should be followed by a high incidence of recurrence. Surprisingly, 6 months and 2 years follow up stripping + HL versus laser randomized studies do not show any difference in recurrences. Moreover, 2 and 3 years follow up randomized studies comparing stripping + HL versus radiofrequency report similar results. Finally, the Closure Fast study, concerning 295 GSVs shows very good results at 3 and 5 years. At the opposite it is now proved that HL induces neovascularization, as in the EVOLVeS study or a recent 5 years follow up study ( 33% in HL versus 0% in no HL).
Stripping without HL was studied in 195 cases with recurrence in 1.8% at two years, and in a randomized trial comparing stripping with (60 cases) and without (60 cases) HL: at 8 years f.u. clinical recurrence was 29% versus 9.8% , while ultrasound showed 32.2% versus 11.4% recurrences.
In the Author’s experience of 8595 cases from 1997 to 2008, the stripping without HL replaced totally the traditional technique since 2005.