There are a handful of surgical procedures that require a general anesthetic and include open and/or laparoscopic or robotic-assisted surgery.

One surgical method is to ligate the insufficient ovarian veins. This is when the surgeon makes two cuts. The first cut is in the location of the top of the vein. The second cut is at the bottom of the damaged vein. The surgeon will tie off the top of the vein to stop blood flow.

Another surgical therapy is a hysterectomy with or without unilateral salpingo-oophorectomy (USO) or bilateral salpingo-oophorectomy (BSO).⁵ A hysterectomy is when surgery is used to remove all or part of the uterus. A salpingo-oophorectomy is when one ovary and one fallopian tube is removed together. This can be done on one side or both sides.

In the recent International Union of Phlebology consensus, they advised against hysterectomy as its efficacy has not being proved convincingly.¹¹ Hysterectomy with BSO remains an option for women who have failed other treatment modalities, but appropriate counseling should be performed.⁴

When compared with endovascular treatment, surgery is associated with longer hospital stay, longer recovery time, and greater morbidity.¹ This approach should be reserved for refractory cases, in patients with debilitating symptoms who are appropriate surgical candidates.⁴

Your suitability should be discussed with your healthcare professional to confirm if you are an appropriate candidate.