At the time of a secondary operation every effort should be made to avoid scar tissue from the previous operation. The procedure is relatively simple, if carried out through clean tissue. If an attempt is made to mobilize an incompetent saphenofemoral junction through scar tissue, the procedure can be time-consuming and exceedingly difficult because of the thick scar tissue and thin, friable recurrent varices. In the majority of secondary operations, the long saphenous vein had not been ligated flush with the femoral vein. In some patients the long saphenous vein had been ligated properly, but the short saphenous vein or incompetent perforators had been missed. If all venous insufficiency is eliminated at its source, the surgical result should be excellent. Any postoperative residual varices can be eliminated by injections of sclerosing solution. Annual examinations are essential, so that if any new varices appear they can be obliterated by injections.