Aim: In varicose veins, traditional surgery for long saphenous vein disease has been saphenofemoral disconnection along with stripping of the vein. This, however, can result in morbidity in the form of pain and bruising. The objective of the study is to evaluate sequential vein avulsion as an alternative to vein stripping. 
Patients and methods: Sixty-one patients with primary varicose long saphenous vein and saphenofemoral incompetence were randomly treated by saphenofemoral flush ligation with either stripping to just below the knee or sequential avulsion. 
Results: There was significantly more pain after stripping during the first postoperative week. The mean pain score was 50, reducing to 20 after one week after stripping compared with 20, reducing to 10, after sequential avulsion. The mean area of bruising measured after one week was 210 (range 20–1830) cm 2 for stripping and 85 (range 10–640) cm 2 for sequential avulsion. Sequential avulsion is less painful, reduces bruising and avoids a significant scar below the knee. There was no significant difference between the two methods as regards the time taken for vein removal. 
Conclusion: Sequential avulsion avoids the inconvenient below knee scar of stripping. It is significantly less painful and 
causes less bruises. The length of surgery is almost the same for both methods and sequential avulsion is reliable in removing the whole LSV without complication.