The classic surgical treatment of hemorrhoidal disease is the excisional hemorrhoidectomy, that consist in the surgical removal of one or more hemorrhoidal cushion, it is considered a safe, radical and definitive treatment; however, it is not exempt of complications and the postoperative pain is considerable. During the last two decades the concept of treatment has evolved to control hemorrhoidal symptoms with less invasive techniques, such as hemorrhoidal bands, arterial ligation Doppler guided hemorrhoidal and more recently, the association of anorectal repair or mucopexia for treating hemorrhoidal mucosal prolapse. The results of the doppler guided transanal dearterialization and rectoanal repair (HAL-RAR) in the treatment of hemorrhoidal disease, show good control of symptoms, less postoperative pain and low rates of complications in the treatment of grade II, III and IV hemorrhoids.1 -10 The advantages of the HAL- RAR could be more limited in advanced hemorrhoidal disease (stage IV), in this stage have been reported a recurrence rate of up to 38% 4.
Install New Order Low-Life Rapidshare Torrent Software - Florida Tampa New Order Low-Life Rapidshare Average ratng: 6,7/10 6335 votes New Order - Low Life Waiting for the Sirens' Call is the eighth studio album by the English rock band New Order. Hey Guys, What is an.rar file and what is the difference between an.rar file versus and.iso file. Does an.rar file have to be uncompressed in.
New Order Low Life Rapidshare Library Downloads
The studies with more patients treated with HAL- RAR are those of Faucheron et al3 (100 patients) and Roka et al6 (77 patients). These studies reported good results in the treatment of grade IV hemorrhoids with a high rate of outpatient treatment, good control of symptoms (89%) and a low rate of complications. Te complications presented 9% in the immediate postoperative period and 4% in the long term, all were treated conservatively. Currently there are few prospective randomized studies that demonstrate the results of HAL- RAR compared with open hemorrhoidectomy, the long-term results remain to be demonstrated. In the literature there are two prospective randomized studies comparing the HAL- RAR with excision hemorrhoidectomy1 -2.
In both studies, good results were observed with these techniques with regard to symptom control; postoperative pain and long-term results were similar with both techniques. The publication of more randomized prospective studies to allow proper evaluation of the results in patients who underwent HAL- RAR is required. Study Type: Interventional (Clinical Trial) Estimated Enrollment: 60 participants Allocation: Randomized Intervention Model: Parallel Assignment Masking: None (Open Label) Primary Purpose: Treatment Official Title: Prospective and Randomized Trial Comparing Dopplper-Guided Transanal Hemorrhoid Artery Ligation With Recto-anal Repair (HAL-RAR) Versus Excisional Hemorrhoidectomy for the Treatment of Grade III-IV Hemorrhoids Study Start Date: September 2014 Estimated Primary Completion Date: July 2016 Estimated Study Completion Date: July 2016. Hemorrhoidal artery ligation and rectoanal repair will be performed with the AMI minimally invasive surgery device HAL/RAR, and consist in the ligation of the terminal branches of the superior rectal artery with 2-0 absorbable polyglycolic acid suture after identifying the blood flow approximately 3 cm above the dentate line by using Doppler guidance. Subsequently, a running suture was added from the suture point to 5 mm above the dentate line to lift the prolapsing hemorroid. Other procedures will not be associated. Procedure: HAL-RAR.
Hemorrhoidal artery ligation and rectoanal repair will be performed with the AMI minimally invasive surgery device HAL/RAR, and consist in the ligation of the terminal branches of the superior rectal artery with 2-0 absorbable polyglycolic acid suture after identifying the blood flow approximately 3 cm above the dentate line by using Doppler guidance. Subsequently, a running suture was added from the suture point to 5 mm above the dentate line to lift the prolapsing hemorroid. Other procedures will not be associated. Inclusion Criteria:. Patients with symptomatic grade III or IV hemorrhoids (bleeding, pain, itching, soiling or prolapse) that are elegible for surgical treatment with both methods. Exclusion Criteria:.
New Order Brotherhood
Associated recto-anal pathology such as acute thrombosed hemorrhoid, anal fissure, perianal fistula, perianal abscess, rectal prolapse, fecal incontinence or anal stenosis. Prior anorectal surgery.
Systemic pathology that could alter the outcome of the surgery as coagulopathies, chronic pain with continued consumption of analgesics. Age younger than 18 or older than 80 years, socio-pathology or inability to understand the study objectives.