Objective: The aim was to examine the effect of various surgical maneuvers during standard surgery for small saphenous varicose veins (SSV). Methods: This was a prospective cohort study of patients that underwent small saphenous varicose vein surgery. Two-hundred nineteen consecutive patients (234 legs) with isolated primary or recurrent small saphenous varicose veins undergoing surgery were enrolled in a multicenter study involving nine vascular centers in the United Kingdom. Operative technique was determined by individual surgeon preference; clinical and operative details, including the use of stripping, were recorded. Clinical examination (recurrence rates) and duplex imaging (superficial and deep incompetence) were evaluated at six weeks and one year after surgery. Results: A total of 204 legs were reviewed at one year; 67 had small saphenous varicose vein stripping, 116 had saphenopopliteal junction (SPJ) disconnection only, and the remainder had miscellaneous procedures. The incidence of visible recurrent varicosities at one year was lower after SSV stripping (12 of 67, 18%) than after disconnection only (28 of 116, 24%), although this did not reach statistical significance. There was no significant difference in the rate of numbness at one year between those who had SSV stripping (20 of 71, 28%) and those who had disconnection only (38 of 134, 28%). The rate of SPJ incompetence detected by duplex at one year was significantly lower in patients who underwent SSV stripping (9 of 67, 13%) than in those who did not (37 of 115, 32%) (P < .01). Conclusion: Stripping of the SSV significantly reduced the rate of SPJ incompetence after one year without increasing the rate of complications.