Question 1

Which are the indications of the Angiodin LDL2 procedure?

Accepted Answer

Stage II, III degree, (with the only exception of an external fibrosis)

Question 2

Does ligature of all of the terminal branches can create a necrosis?

Accepted Answer

No, because you only ligate the branches of the superior rectal artery, which contributes exclusively to the functional blood supply of the cushions while the mean and inferior rectal arteries are left intact.

Question 3

Are cases of sepsis or rectal abscesses reported?

Accepted Answer

No, with thousand of patients treated with this technique worldwide, not a single case of sepsis or abscesses have been reported.

Question 4

Are those cases of tenesmus described, the result of a technical problem, while performing the procedure?"

Accepted Answer

No, tenesmus is a minor symptom which disappears after the few first days, logically due to the mucosal pexis in the anal canal. The starining envy is due to the filling of the rectal apula (you should advise the patient ”not” to strain.

Question 5

Are cases of stenosis been reported?

Accepted Answer

No, however do make sure not to create a restriction of the anal canal by stitching together distant parts of it. (the stitches should be well separated, at a digital examination).

Question 6

When in doubt of having applied a stitch too superficial or too close to the dental line, what can be done?"

Accepted Answer

One of the advantages of this procedure is that, at any time, it can be undone. Repeat the stitch.

Question 7

Can this technique be performed in“redo”cases of therelapses of othertechniques?

Accepted Answer

Yes, with no adverse expected results.

Question 8

Can this technique be performed in cases of acute thrombosed piles or anal fistulas?

Accepted Answer

No, it I recommended to wait sometime after having treated the acute symptoms.

Question 9

Can this technique be performed in cases of anal fissures?

Accepted Answer

Yes, it may even be recommended on those patients where the sphincter hypertone associated with fissures results in symptomatic haemorrohoids.

Question 10

Is general or spinal anesthesia required for performing the procedure ?

Accepted Answer

Yes it is recomanded due to the size of the proctoscope (34mm).

Question 11

What type of analgesic drugs are recommended in the post-op?

Accepted Answer

In our experience, over 50% of the patients do no require any analgesia. If needed, recommend oral analgesics.

Question 12

The tissue lifted by the continuous suture pexis does not slide down again once the sutures are absorbed?

Accepted Answer

No because a fibrosis forms in the first 4 weeks, which holds the tissue together, fixated to the anchorage in the sub mucosa.

Question 13

What is reported relapse rate?

Accepted Answer

Both on bleeding and prolapse, less than 7%.

Question 14

And in advanced VI degree cases?

Accepted Answer

Could be done but requires a certain experience and results shall be confirmed but further studies.

Question 15

Which are the complication reported?

Accepted Answer

Very minors: Anal fissures (2%); Thrombosed Piles (2%); Bleeding-usually spontaneously resolved (2%); Sub-mucosal haematoma (2%).

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