RESUMEN
Introduction: HAL-RAR is a new, minimally invasive technique for the treatment of haemorrhoids, whereby Doppler-guided ligation of the haemorrhoidal arteries (HAL) is combined with a mucopexy of the prolapsed haemorrhoidal tissue (RAR = Recto Anal Repair). Methods: We did these operations as an alternative to the conventional haemorrhoidectomies in the cases of grade III or - in some cases - grade II haemorrhoids. Between August 2017 and April 2019 a total of 45 patients were operated on with the HAL-RAR procedure. All operations were done under general or spinal anaesthesia. Results: Complications were seen in three patients within 30 days of surgery. One patient had proctitis, one patient suffered from a thrombosed haemorrhoid, while one patient had bleeding, which occurred on the 16th postoperative day. Two of them needed re-operation. Except one patient, all of them was treated in one-day surgery. HAL-RAR seems to be less painful than conventional procedures and causes more patient satisfaction in the early postoperative period. Neither the bleeding, nor the pain did not re-appear after 1 year, but one patient mentioned recurrence of the prolapse. Conclusion: Doppler-guided suturing is an effective, minimally invasive treatment option for even advanced haemorrhoidal diseases and seems to be ideal for one-day surgery.
Asunto(s)
Hemorreoidectomía , Hemorroides , Canal Anal , Hemorroides/terapia , Humanos , Ligadura , Resultado del Tratamiento , Ultrasonografía IntervencionalRESUMEN
INTRODUCTION: Two hundred and three patients were operated on with rectal malignancy between 2007 and 2014 in our surgical department. METHODS: Of these, patients who had cancer within 16 cm of the anal verge were included. 73 patients received neoadjuvant treatment and 130 patients were treated with primary resection. The specimens were graded by the Dworak and the Rödel regression score system. RESULTS: We found strong response in 45 patients and pathologic complete remission in three patients. 5-years survival was compared in the two groups operated between 2007 and 2009. While the overall survival rates were just the same, we can report that response to neoadjuvant therapy is a strong predictor of disease free survival. The incidence of loco-regional recurrence was lower in patients who received neoadjuvant treatment compared to the ones who underwent primary resection. Postoperative complications, incidence of anastomotic leakage were also analysed. We did not find increase in the postoperative complications in the group of patients with neoadjuvant treatment.