Alternatively the running suture can be placed immediately after the ligation.
using the same suture material. The mucopexy can also be performed with ease using the AMI HAL doppler system.
the AMI are flexi probes made up of two components
in the inner part that is connected firmly to the handle
and in outer sleeve the can be rotated
the handle is moved to the starting position used for ligation
ligation window and hence the handled point to the position requiring treatment
the RAR flexi probe must be inserted into the rectum in such a way that
the prolapse can be lifted to maximum effect as for hal amides five eight hal needle is inserted into the initial stitch placed
if necessary the mucosa can be pulled gently into the RAR probe after making the first stitch to allow more proximal placement of the second one
this results in the C- shape stitch
by success of turning of the handle
more and more mucosa becomes visible proceeding step-by-step is important to prevent all the mucosa of falling into
the probe ligation window at once continuing in this fashion the surgeon places a running suture which ends
between five and ten millimeters proximal of the dented line still in the pain-free area the individual stitches of the running suture place some seven to ten millimeters apart
allowing room for four to five stitches in total
once the last stich have been placed above the dented line the needle is cut off in the upper end of the suture material you know by the initial sketches vannatter to the distal end of the suit your this causes the prolapse to be pulled up in the direction of the initial stitch
word has been than second in the place for the sliding knot the number of new capacities differs from patient to patient and the surgeon will decide how many are necessary as the operation proceeds as a general rule between two and four running sutures are required
however it is certainly possible to perform more or even fewer the RAR precision probe is the second type of rar probe available in contrast to the rar flexi probe
the precision probe has a column shaped part designed to standardize the new mucopexi the first part of the operation
the ligation of the arteries remains the same to carry out the new mucopexi the outer sleeve is turned in such a way that the conscious part of the probe is positioned directly underneath the sleeves mucopexi window now the probe is inserted rectly whereby the opening of the sleeve should be positioned where the first mucopexi will be performed the teeth of the RAR position probes karma hold that most of mucosa weaving just spaces between the teeth free to work on as before the running suture is now place from proximal to distal and care must be taken to place the last-ditch far enough proximal of the dented line so that no pain has experienced post operatively by the patient
once the last stitch been placed the handel is turning a clockwise direction to release the suture now the prolapse can be lifted as previously described by pushing the sliding knot in the direction of the initial proximal stick and than securing it the new capacity with the rar precision probe can be carried out at several prolapse positions if necessary because the prolapse nghemorrhoidal cushions are secured in place in the rectum the result of the pro that street ms usually visible immediately there are method can must be considered equally effective for treating the symptoms of hemorrhoids as well as the prolapse the symptoms by means of the precise ligation and the prolapse by means of the new mucopexi