Doppler-guided hemorrhoidal artery ligation with hemorrhoidopexy: source and prevention of XXXX .

@entity1 @entity282 @entity158 @entity6713
BACKGROUND: Transanal @entity6713 , although it showed reliability, has not completely removed the issue of @entity282 . OBJECTIVE: We investigated the causes of @entity282 and proposed some changes of the technique in order to eliminate it. @entity1 : One hundred six out of 188 operated @entity1 were considered. @entity282 was investigated using a Visual Analogue Score dividing @entity1 into three groups: 0 to 3, 4 to 6, and 7 to 10. On the basis of these results, we proposed some variations of the technique. A second group of 25 @entity1 was therefore treated with the modified technique. Statistical analysis was conducted using the Fisher's exact test, two-tailed. MAIN OUTCOME: @entity158 intensity, surgical approach, and changes in the technique were analyzed, and a new proposal for a modified technique has been developed. RESULTS: The group of 106 @entity1 , 64 males and 42 females, were divided: 71 III grade and 35 IV grade. @entity158 was detected in 37 cases (35  %).Fifteen males (23.50  %) were divided as follows: 8 mild and 7 medium or intense. Twenty-two females (52.38  %) were divided as follows: 11 mild and 11 with medium or intense. For what concerns the variable grade, the @entity158 was present in 15 III G and 22 IV G with statistic significant difference (p value 0.00333). Among the 18 @entity1 (7 males and 11 females) who had severe @entity158 , they all had a number of mucopexies >4, while among 19 @entity1 (8 males and 11 females) with mild @entity158 , only 5 had a number of mucopexies >4, resulting in a statistic significant difference (p value 0.031). In the second group, @entity158 was drastically reduced. LIMITATIONS: We believe it is necessary to extend the sample in order to definitively adopt the proposed amendments. CONCLUSIONS: The review of the causes of @entity282 and the changes adopted compared with those proposed in literature have allowed us to greatly reduce @entity282 .
