Comparative audit of colorectal resection with the POSSUM scoring system

long saphenous vein in the thigh'.We cannot agree therefore that high perforator disease is uncommon in recurrent disease.We would wish to stress the importance of stripping the long saphenous vein in the thigh in order to prevent this occurrence.Their conclusions are also weakened by the fact that details of offer no corroboration of their duplex findings by comparing them with either operative findings or any other diagnostic modality.This leads us to the second point regarding their assertion that duplex ultrasonography should be performed in all patients with recurrent varicose veins being considered for further intervention.We do not agree with the unreferenced statement in their introduction that, in the context of recurrent varicose veins, the 'accuracy of duplex has been established'.For example, we have recently reported the results of a prospective study of 36 consecutive patients with recurrent varicose veins emanating from the groin, in which the ability of clinical examination, handheld Doppler, duplex ultrasonography and varicography accurately to assess the saphenofemoral complex was compared with operative findings.This study showed clearly that, when compared with operative findings, duplex ultrasonography was extremely insensitive (42 per cent)2.In addition, it was clear from this study that varicography was by far the best method of accurately determining the precise anatomic pattern of recurrence at or around the saphenofemoral complex.This impression is confirmed by another study examining the role of varicography in the assessment of recurrent varicose veins'.We would be interested to know whether the authors have attempted to assess the accuracy of their duplex scans by comparing them with operative findings and/or varicography.In summary, although we agree that duplex scanning may be a useful modality in the assessment of patients with recurrent varicose veins, in the scarred previously operated groin it is not sufficiently reliable to be considered as the 'gold standard'.In general, the conclusions that can be drawn from this study about the pattern of recurrence are severely limited as the authors offer no form of validation in order to support the accuracy of their duplex findings.