S hall we mark all this lady's varices preoperatively?" Depending on the training program he is in the resident will get any one of several answers from his attending. The number of combinations of strippings, excisions, and injections routinely used approaches the number of surgeons treating this common malady.
Unless he is one of the rare devotees of sclerosing therapy alone1 surgeons are agreed that stripping of the main incompetent saphenous trunks is the foundation of the treatment plan. Disagreement, however, surrounds the amount of excision or localized strippings to perform in addition. This ranges from total removal of all visible varices, following which few if any injections are needed, to simple stripping of the incompetent "mother" veins followed by injections as indicated.
In this issue Lofgren and Lofgren present data on patients with varices recurrent after prior stripping. By making careful notes they identified the omissions at the prior