Objective: the aim of this study is to clinically test the efficacy of a new approach for patients having symptomatic grade III and IV hemorrhoids. Material and method: 32 patients (17 females) complaining of grade III or IV hemorrhoids were included in the study. A specially designed proctoscope coupled with a Doppler transducer on its tip was used to identify the hemorrhoidal arteries, which were afterwards suture ligated. Operating time as well as per-and postoperative complications were anlyzed. Follow-up was planned following discharge after 1 week, 1 month, 6 months and 1 year. Results: mean operation time was 27 (range 18-43) minutes, and 5 (range 4-7) arteries were located on average. No patient had severe or moderate postoperative pain, with anal discomfort being the main complaint. Rectal bleeding and tenesmus were the commonest post-operative complications. After one year of follow-up, 19 patients were free of symptoms and 6 of them had significant symptom relief. According to grade, the technique failed in just 3 grade III patients, but in as many as 4 grade IV hemorrhoid cases. Conclusions: doppler-guided hemorrhoid artery ligation is an easy-to-perform technique that is well accepted by patients and has good results for grade III hemorrhoids.

Meniscal injuries are extremely common in the general and athletic populations. The management strategy has switched from meniscectomy to meniscal-preserving techniques. It is nowadays extensively accepted that surgeons have to do their best to repair the meniscus and try to preserve as much tissue as possible. However, in many cases the tissue quality is poor and the tear pattern is complex. In such scenarios, meniscal repair has a lower success rate. In the present surgical technique, an arthroscopic all-inside circumferential-surrounding meniscal repair technique is presented. Any meniscal tissue or the meniscal rim is first debrided to a bleeding bed. Then, an all-inside device is used to create vertical sutures from capsule to capsule surrounding the entire meniscus (circumferential-surrounding). Care should be taken not to tighten the suture too much to avoid cutting the meniscal tissue. This easy and effective repair technique “packs” the meniscal tear fragments altogether and allows the surgeon to save the meniscus when facing with irreparable, degenerative, complex meniscus tears.

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