scholarly journals Application of endovideosurgery in the treatment of ventral hernias after gunshot wounds of the abdomen

2018 ◽  
Vol 22 (3) ◽  
pp. 471-473
Author(s):  
M.A. Kashtalian ◽  
O. S. Herasymenko ◽  
R.V. Yenin ◽  
A.A. Kvasnevskiy
Keyword(s):  
Surgical Treatment ◽  
Abdominal Cavity ◽  
Gunshot Wounds ◽  
Surgical Interventions ◽  
The Third ◽  
The Past ◽  
Abdominal Organs ◽  
Laparoscopic Techniques ◽  
Ventral Hernias ◽  
Abdominal Compartment

Gunshot wounds of the abdomen are often accompanied by a significant destruction of the abdominal cavity with the development of peritonitis, and in the future — various complications (failure of anastomoses, abscess formation, repeated bleeding, etc.), which requires repeated surgical interventions, and as a consequence — the formation of postoperative ventral hernias. The aim of the study is to improve the results of surgical treatment of ventral hernias after gunshot wounds of the abdomen due to the use of laparoscopic techniques. The analysis of treatment of 21 patients with postoperative ventral hernias formed as a result of operations concerning gunshot wounds of the abdomen was carried out. 14 wounded suffered one operation on the abdominal organs in the past (66.7%), 5 — two operations (23.8%), 1 — three operations (4.8%), 1 — five operations (4.8%). The dimensions of the hernial gates and the risk of recurrence were determined according to the SWE classification: W1 — 9 patients (42.9%), W2 — 8 (38.1%), W3 — (9.5%), W4 — 2 (9.5% ). The third patients underwent laparoscopic allogernioplasty according to the IROM technique with a Teflon allograft, which was fixed in 2 cases with the help of a herniostepler, in the 1st — with transdermal separate seams with Teflon filament. Complications after laparoscopic operations were not. The use of laparoscopic techniques can significantly reduce bed-day, avoid the development of abdominal compartment syndrome, previously to activate the patient. Laparoscopic allogernioplasty according to the method of IPOM by the Teflon graft is considered to be the operation of choice.

scholarly journals Features of laparoscopic hernioplasty of paracolostomy hernias in patients with combined abdominal pathology

2020 ◽  
Vol 24 (4) ◽  
pp. 600-603
Author(s):  
K. Yu. Parkhomenko
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Average Length ◽  
Abdominal Cavity ◽  
Surgical Interventions ◽  
Surgical Department ◽  
Inguinal Hernias ◽  
Laparoscopic Hernioplasty ◽  
Commercial Enterprise ◽  
Laparoscopic Techniques ◽  
Ventral Hernias

Annotation. The aim of the study is to study the technological features and results of simultaneous laparoscopic hernioplasty of paracolostomy hernias in the presence of combined abdominal pathology. We analyzed the results of surgical treatment of 11 patients with paracolostomy hernias who were treated in the surgical department of the Municipal non-commercial enterprise of the Kharkov regional council “Regional Clinical Hospital” from 2016 to 2020, of whom – women – 4 (36%), men – 7 (64%), aged from 42 to 69 years old. Clinical, anamnestical and instrumental data for the prolongation of cancer were not identified in all patients. Out of 11 patients, in addition to paracolostomy hernia, 3 (27%) had inguinal hernias, 8 (73%) had postoperative ventral hernias. 3 (27%) patients with hernias also had cholecystolithiasis. All patients underwent laparoscopic hernioalloplasty of paracolostomy hernia. 3 patients underwent simultaneous TAPP for inguinal hernias, and 1 patient underwent laparoscopic cholecystectomy and TAPP. 6 patients with incisional ventral hernias underwent simultaneous IPOM according to the standard method, and 2 – according to the own method. Of the above, 2 patients suffering from cholecystolithiasis, in addition to hernioalloplasty, underwent laparoscopic cholecystectomy. In 4 (36%) patients, viscerolysis was additionally performed due to the presence of an adhesive process in the abdominal cavity. Simultaneous hernioalloplasty TAPP and IPOM, as well as laparoscopic cholecystectomy, had no significant effect on the development of complications and the duration of hospitalization. The average length of inpatient treatment was 9.2 bed-days. The study proves the expediency of widespread simultaneous surgical interventions for hernias of the anterior abdominal wall, as well as the preference for laparoscopic techniques.

scholarly journals Surgical tactics for victims of gunshot wounds of the diaphragm specialized stage of medical care in conditions of a modern armed conflict

2019 ◽  
Keyword(s):  
Surgical Treatment ◽  
Medical Care ◽  
Comparison Group ◽  
Care Delivery ◽  
Abdominal Cavity ◽  
Surgical Care ◽  
Gunshot Wounds ◽  
Main Group ◽  
Lung Capacity ◽  
Combat Injuries

Introduction. The diaphragm gunshot wounds are serious combat injuries. The main functions of the diaphragm are to change the intra-abdominal pressure and the outflow of lymph and blood from the abdominal cavity due to the constant contraction and relaxation. Therefore, when it is injured at the same time with a powerful painful impulse, cardiopulmonary disorders quickly arise. Purpose: To improve the results of surgical treatment of patients with gunshot wounds through the introduction of new video endoscopic technologies at the stage of specialized surgical care. Materials and methods. The article analyzes the features of specialized surgical care in 64 patients with gunshot wounds who were treated at the surgical clinic of the Military Medical Clinical Center of the Northern Region (III level of medical care). New minimally invasive methods are proposed to improve the outcomes of surgical treatment of victims with diaphragm gunshot wounds at level III of health care delivery. Results. Thus, the use of video thoracoscopic technique in the surgical treatment of the diaphragm wound and its suturing in the proposed method allowed to improve the results of treatment by increasing the average value of diaphragmatic excursion in deep breath in the main group to 3.73 ± 0.31 cm, whereas in the comparison group 2.21 ± 0.38 cm. The severity of the pain syndrome on the of Visual Аnalogue Scale 5 days after surgical treatment was 5.2 ± 2.3 points in the injured main group, 6.7 ± 2.1 points in the comparison group. The ratio of vital lung capacity to the required vital lung capacity in the main group was 75.3 ± 2.2%, in the comparison group 64.1 ± 1.7%. Conclusions. The use of video thoracoscopy increases the efficiency of the diagnosis of gunshot wounds of the diaphragm. The use of laser imaging and fluorescence diagnosis of diaphragm wounds ensure the adequacy of the removal of paravulary necrotic tissues. The suturing of the wounds in accordance with the anatomical and functional structure of the diaphragm with the use of plaques improves the immediate postoperative results of surgical treatment.

scholarly journals Gallbladder polyps: the more cases we observe, the more questions we ask

2020 ◽  
Vol 48 (3) ◽  
pp. 85-90
Author(s):  
N. V. Shirinskaya ◽  
N. V. Kalyatina ◽  
A. V. Shirinskaya
Keyword(s):  
Ultrasound Examination ◽  
Abdominal Cavity ◽  
Statistical Processing ◽  
Observation Data ◽  
Outpatient Appointment ◽  
Surgical Interventions ◽  
Gallbladder Polyps ◽  
Abdominal Organs ◽  
Ultrasound Study ◽  
History Of

Background. Gallbladder polyps have recently become more common in practice of general practitioners and gastroenterologists due to the improvement of instrumental imaging of the abdominal cavity. Aim of study: to analyze the dynamics of development of gallbladder polyps at an outpatient appointment of a general practitioner (gastroenterologist). Materials and methods. A prospective clinical five-year study of patients with gallbladder polyps was conducted. All patients underwent ultrasound examination of the abdominal organs (Voluson E10) once every six months during five years. Number and nature of the growth of polyps, size of the gallbladder, presence/absence of complaints, and burdened history of neoplastic diseases were evaluated in the dynamics of observation. Data obtained were subjected to standard statistical processing. Results. The study included 33 patients (14 men, 19 women aged 24–65 years, average age 45.19±1.73 yrs). In the initial ultrasound study, the number of visualized polyps varied from 1 to 5 (on average, 2.09±0.95), the size of the neoplasms ranged from 2 mm to 10 mm (on average, 5.75±1.10 mm). Burdened heredity in oncopathology was noted in 42.86% of men and 31.58% of women. Legless polyps were more often diagnosed in men (14.29%), while in women, polyps increased in size in the dynamics of observation >10 mm and a higher frequency of surgical interventions (cholecystectomy) were more often recorded. Conclusion. Gallbladder polyps tend to grow slowly. We outlined the questions facing the clinician in the management of patients with gallbladder polyps in terms of choosing the optimal tactic and surgical treatment due to the possible malignancy of these formations.

scholarly journals The option of surgery for gastric stump cancer in patients who have previously undergone pancreaticoduodenectomy

2021 ◽  
Vol 102 (1) ◽  
pp. 100-103
Author(s):  
F Sh Akhmetzyanov ◽  
N A Valiev ◽  
V I Egorov ◽  
M I Shaymardanov
Keyword(s):  
Surgical Treatment ◽  
Digestive Tract ◽  
Stomach Cancer ◽  
Professional Training ◽  
Abdominal Cavity ◽  
Benign Disease ◽  
Gastric Stump ◽  
Previous Surgery ◽  
Gastric Stump Cancer ◽  
Abdominal Organs

Gastric stump cancer is a carcinoma which forms no earlier than 5years after surgery for benign disease. The incidence ranges from 2.4 to 5% among patients with stomach cancer. Previous operations lead to the emergence of an adhesive process in the abdominal cavity, changes in the anatomy and topography of the abdominal organs, as well as the development of new ways of lymph outflow. These factors lead to the re-surgery becomes technically more complicated and requires high professional training from the surgeon. Of particular surgical interest is the issue of restoration of the digestive tract, which directly depends on the nature and volume of the previous surgery. In this paper, the authors describe cases of surgical treatment of gastric stump cancer in two patients, who had previously undergone pancreaticoduodenectomy.

scholarly journals Method for the prevention of postoperative ventral hernias during surgical interventions on the anterior abdominal wall

2020 ◽  
Author(s):  
Valentine Madyarov ◽  
Maulen Malgazhdarov ◽  
Yerik Kaliaskarov ◽  
Gulnara Zhapbarkulova ◽  
Karakoz Amantayeva
Keyword(s):  
Abdominal Wall ◽  
Ventral Hernia ◽  
Abdominal Cavity ◽  
Late Complication ◽  
Diagnostic Methods ◽  
Collagen Content ◽  
Postoperative Rehabilitation ◽  
Surgical Interventions ◽  
Abdominal Organs ◽  
The Relationship

Introduction: ostoperative ventral hernia (PVH) is a protrusion of the abdominal organs (intestinal loops, omentum, etc.) beyond the abdominal wall through a postoperative space or a scar. Prevention and treatment of external abdominal hernias is one of the urgent problems of modern surgery. PVH is a serious late complication following surgery found in 5%–14% of patients. Aim: The aim of the study was to define the most important measures to prevent the occurrence of ventral hernia relapses, as well as to predict the occurrence or relapse by determining collagen content. Material and methods: The main objective of the study was to formulate the main preventive measures of ventral hernia relapses using a method to determine collagen content. Ultrasound examination of the abdominal cavity was used as one of the safest and most advanced diagnostic methods for PVH diagnostics. During the study, a retrospective analysis of 277 case records was used to determine the main causes of ventral hernia relapses and justify the need to prevent PVH relapses. Results and discussion: In this study, the authors try to develop a scheme for optimal postoperative rehabilitation of the patients to prevent ventral hernia relapses, ways to prevent PVH recurrences in the experiment and to determine the relationship between the risk of PVH and relapses associated with collagen. A comprehensive study consisting of three stages was conducted. Conclusions: As a result, a conceptual model was developed to improve the prevention of PVH and its relapses.

scholarly journals Surgical correction of the chronic liver purulent-septic lesions

2019 ◽  
Vol 41 part 2 (2) ◽  
pp. 12-18
Author(s):  
O. G. Kotenko ◽  
A. V. Gusev ◽  
O. O. Popov ◽  
A. V. Grinenko ◽  
M. S. Grigoryan ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Comparison Group ◽  
Abdominal Cavity ◽  
Chronic Liver ◽  
Study Group ◽  
Anatomical Resection ◽  
Duration Of Treatment ◽  
Surgical Interventions ◽  
Liver Abscesses ◽  
Resection Of The Liver

Purpose of the study. The purpose of the study is to improve the results of surgical treatment of patients with purulent-septic lesion of the liver substantiating the indication for resection method use. Material and methods. The work is based on a comparative analysis of the results of examination and treatment of 64 patients aged 10 to 81 years old, with chronic liver abscesses in the department of surgery and liver transplantation during the 1995–2016 periods. According to the tasks of the study patients are divided into two groups. In 30 (46,8%) patients (the study group), various types of anatomical resection of the liver with a purulent lesion were performed without its dissection during the operation; in 34 (53,2%) patients (group of comparison) they performed the disclosure, sanation, drainage of purulent cavity. The majority of patients with chronic liver abscesses treated the abscess with a puncture or drainage method under the control of ultrasound in other medical institutions of Ukraine. Results. The results of diagnosis and treatment of 64 patients for chronic liver abscesses from 1995 to 2016 are analyzed. In the study group, the patients performed anatomical resection of the liver, in the comparison group – standard surgical interventions – the disclosure and drainage of the abscess of the liver. The duration of antibiotic therapy after surgery in the comparison group is significantly higher than in the study group, respectively, 22 ± 3,4 and 5,75 ± 1,6 days; p < 0,001. Second-line antibacterial drugs after draining operations were used more often (p < 0,001) than after resection interventions, respectively, in 94,1 and 6,6% of cases. The duration of treatment of patients in the hospital after surgery in the study group was less than in the comparison group, according to 15,1 ± 0,7 and 27,3 ± 3,05 days; total 25,9 ± 1,4 and 45,7 ± 3,45 days (p < 0,001). After drainage operations, drainages from the abdominal cavity were removed later than after resection interventions, respectively, 17,1 ± 2,8 and 6,35 ± 1,1 days (p < 0,001), through. Conclusion. Resection for chronic purulentseptic lesions of the liver is the priority methods of surgical treatment. The analysis of the obtained results allows us to conclude that resection technologies contribute to the rapid normalization of physical and social rehabilitation of patients with septic liver damage. Keywords: liver abscess, liver resection, chronic, purulent-septic.

scholarly journals PUNCTIONAL DRAINAGES UNDER ULTRASOUND CONTROL IN ABDOMINAL SURGERY

2018 ◽  
Vol 14 (1-2) ◽  
pp. 49-53
Author(s):  
R.A. Sydorenko
Keyword(s):  
Abdominal Cavity ◽  
Surgical Care ◽  
Operative Management ◽  
Pathological Process ◽  
Term Treatment ◽  
Main Task ◽  
Complex Treatment ◽  
Surgical Interventions ◽  
Endogenous Factors ◽  
Abdominal Organs

Relevance. Punctic-drainage interventions under the control of ultrasound have become an effective help in complex treatment. But some technological aspects in the procedure and post-operative management of patients remain the subject of discussion. Objective: to improve the results of the use of punctional drainages under ultrasound control in abdominal and retroperitoneal pathology. Materials and methods. Echo-controlled puncture-drainage interventions are used in 89 patients: with pancreatogenic fluid concentrations in the stuffing box, parapancreatic cellular spaces (34); with intra-abdominal complications following operations on the abdominal organs (18), inflammatory processes in the gall bladder (15), tumor obstruction of the bile ducts (12), and with liver abscesses (10). Depending on the nature of the contents of the "target", its localization for puncture drainage was used by trokars of various modifications and diameters, as well as stylet-catheters of the type "PIGTAIL". Manipulation was carried out using ultrasonic devices with convection (frequency 3.5 MHz) and linear (frequency 7-12 MHz) sensors. In 68 patients, the display for intervention was infected fluid formation. In 12 – jaundice syndrome and 9 patients – sterile clusters of enzymatically active content. The main task of puncture-drainage procedures was the evacuation of the content of pathological or anatomical fluid formations to reduce intoxication and (or) their decompression. In assessing the effectiveness of minimally invasive techniques, account was taken of the effectiveness of the operation, that is, the target effect for which the intervention was performed, and the number of complications. Results. Puncture-drainage interventions have become independent and end-of-term treatment in 68 out of 85 cases (with the exception of 4 patients who, due to complications during the procedure, used other methods). The reasons for the reduced effectiveness of echo-controlled puncture-drainage interventions in 9 patients were: the predominance of the tissue component (large sequester) in the cavity, the presence of multiple isolated gates, the use of drainage structures with insufficient drainage properties. Fatal consequences in 5 patients are caused both by the above reasons, and by endogenous factors (a significant prevalence of the pathological process, decompensated background pathology, reduction of internal reserves of the organism). Conclusions. Puncture-draining interventions under ultrasound control are an alternative to open surgical interventions, especially in patients with severe concomitant pathology, severe general condition. In this case, they can be as element (stage) of complex treatment and an independent, final method of surgical care. The choice of echo-controlled interventional technologies as a method of operational correction should be carried out with understanding their capabilities. The effectiveness of such mini-invasive methods allows us to recommend their acceptance in surgical hospitals for diseases of the abdominal cavity organs and retroperitoneal space.

scholarly journals Morphological changes of a great omentum at implantation of polypropylene and composite prostheses at allohernioplasty

2019 ◽  
Vol 25 (4) ◽  
pp. 62-69
Author(s):  
О.О. Vorovskyі ◽  
V.O. Shaprynskyі ◽  
I.M. Sadyk
Keyword(s):  
Morphological Changes ◽  
Abdominal Cavity ◽  
Great Omentum ◽  
Composite Mesh ◽  
Blood Capillaries ◽  
Intraperitoneal Onlay Mesh ◽  
Abdominal Organs ◽  
Mesh Method ◽  
Onlay Mesh ◽  
Ventral Hernias

To date, allohernioplasty of giant postoperative ventral hernias retains high postoperative mortality and a significant number of postoperative complications. The purpose of the study is to investigate the possibility of intraperitoneal use of polypropylene and composite implants in allohernioplasty of postoperative giant ventral hernias by studying the morphological changes of the great omentum. The results of surgical treatment of 146 patients with postoperative giant ventral hernias were investigated. To this group of patients with allohernioplasty by the method onlay was performed 22 (15.1%) patients, by the method sublay – 46 (31.5%), by the method inlay – 52 (35.6%), with intra-abdominal placement of the mesh by the method onlay (intraperitoneal onlay mesh) – 26 (17.8%). 32 (21.9%) patients who underwent surgery using the sublay method polypropylene implant was fenced off from the abdominal organs with a great omentum, 22 (15.1%) patients operated on by the intraperitoneal onlay mesh method composite implant was also fenced off from the abdominal organs by a great omentum. In 8 (5.5%) patients from the group of patients who were operated on by the sublay method and in 6 (4.1%) – operated by the intraperitoneal onlay mesh method for 14-18 days patients developed signs of chronic intestinal obstruction, where the cause was postoperative adhesive illness. The study of the effect of polypropylene prosthesis on a great omentum was performed on 8 outbred dogs and 6 outbred mature dogs, who were implanted with a composite mesh unilaterally covered with oxycellulose. The polypropylene implant has been shown to have a greater capacity for the development of adhesive processes. However, if a great omentum to protect this prosthesis from the abdominal cavity then the first zone (active inflammation) spread in 155 microns (increase in the number of blood capillaries of the microcirculatory bed, thickening of the arterioles wall, venous full blood flow, diapedesis of leukocytes through the wall of the blood cells), the second zone (sclerosis) – up to 40 microns (increase in the number of macrophages and lymphocytes. proliferation of fibroblasts). In the future, the structure of the omentum was almost indistinguishable, so with allohernioplasty by the developed method, it was possible to prevent the development of adhesive disease on the intestine. This study confirmed the limited spread of the inflammatory response, which allows the implant of a polypropylene mesh on a great omentum. In the composite mesh, the composite mesh was spliced with surrounding tissues from the side where there was no gel coating, and from the side of the salivary coating, the “readiness” to spread the inflammatory process (vasculitis with pronounced lympho-plasmocytic infiltration of the vessel walls and perivascular ductus), therefore, left it is also necessary to enclose it with a large omentum from intestium.

Uterine fibroids, laparoscopic surgery and morcellation. Literature review

GYNECOLOGY ◽  
2019 ◽  
Vol 21 (3) ◽  
pp. 22-25
Author(s):  
Alexander A Seregin ◽  
Anastasiia B Nadezhdenskaya ◽  
Aleksandra V Asaturova ◽  
Dmitry L Ovodenko
Keyword(s):  
Laparoscopic Surgery ◽  
Surgical Treatment ◽  
Abdominal Cavity ◽  
Uterine Fibroids ◽  
Extraction Process ◽  
Uterine Myoma ◽  
Historical Aspect ◽  
Surgical Interventions ◽  
Oncological Safety ◽  
High Level

Aim. To analyze the literature data on modern approaches to morcellation of myomatous nodes in laparoscopic surgery and to highlight this area in a historical aspect. To form an idea of the main difficulties associated with morcellation, which contributed to and contribute to the improvement of the technique of this manipulation. Materials and methods. The review includes data from foreign articles published in the elibrary.ru and PubMed databases on this topic. Results. It describes both modern trends in the surgical treatment of patients with uterine myoma, and historical aspects of improving methods aimed at reducing risks, reducing the time of surgical intervention and improving its safety. Analyzed data on the use of electromorcellation, carried out both with the use of plastic containers, and without them. Conclusion. High requirements for surgical interventions contributed to the emergence of such a method of intracorporeal fragmentation of drugs, such as morcellation, which led to a significant reduction in the proportion of laparotomic operations in the treatment of patients with my uterus. The introduction of laparoscopy in the surgical treatment of uterine myoma allowed to achieve a fundamentally new high level of rehabilitation of patients. Removing removed drugs from the abdominal cavity is associated with a certain risk. Despite the significant number of proposed methods and devices for morcellation, they all require further improvement, since it is necessary to completely exclude contact of the myoma node tissue with abdominal organs in the extraction process. Currently, active research continues on ways to realize all the benefits of minimally invasive technologies in compliance with the rules of oncological safety.

scholarly journals SURGICAL TREATMENT OF PATIENTS WITH CHRONIC HEMORRHOIDS

2020 ◽  
pp. 137-142
Author(s):  
S. M. Vasilyuk ◽  
A. G. Shevchuk ◽  
V. I. Gudyvok ◽  
I. R. Labiak ◽  
S. S. Sidoruk
Keyword(s):  
Surgical Treatment ◽  
Laser Coagulation ◽  
Surgical Interventions ◽  
The Third ◽  
Early Postoperative Complications ◽  
Open Hemorrhoidectomy ◽  
The World ◽  
Median Period ◽  
Closed Hemorrhoidectomy ◽  
Surgical Treatments

Symmary. About 300 surgical treatments for hemorrhoids are known now. The most common method in the world remains the Milligan-Morgan operation and its numerous modifications. These surgical interventions are essential in the choice of surgical treatment for chronic hemorrhoids. However, both open and closed hemorrhoidectomy have their disadvantages. Purpose. To study the effectiveness of various surgical treatments for patients with chronic hemorrhoids using a laser coagulator. Materials and methods. We conducted a clinical examination and treatment of 140 patients with chronic grade III-IV hemorrhoids by Goligher. All patients were presentably divided into three groups. The first group included 60 patients who had classic open hemorrhoidectomy - the Milligan-Morgan operation. The second group included 40 patients in whom had surgical treatment with a laser coagulator - laser open hemorrhoidectomy. The third group consisted of 40 patients who underwent laser open hemorrhoidectomy, supplemented with laser transcutaneous submucosal mucopexia. Results and discussion. Analyzing the indicators of pain in different groups of patients at different postoperative period, we found that on the first postoperative day the classic Milligan-Morgan surgery, the was most uncomfortable procedure (the first group of patients). Among the patients in the second and third groups there were no people who rated pain above 7 points. In the first group, the median period of first defecation was in 5.0 days. As for in patients of the second group, the first defecation was observed in terms of the 3-5 days with a median of 4.0 days. A similar indicator was observed in patients of the third group. Patients in the second and third groups did not indicate severe pain during the first act of defecation. The anal hematoma was found only in patients of the first group (p<0.01). Anal infiltration occurred in 12.5±5.23 % in the third group (p<0.01). Infections of wounds were not found in any group. Conclusion. Laser open hemorrhoidectomy is an effective method of surgical treatment of patients with chronic hemorrhoids. However, like the classic open hemorrhoidectomy Milligan-Morgan, it allows to eliminate only pathological substrate (cavernous bodies). To prevent recurrence of the disease, it should be supplemented with laser transcutaneous submucosal mucopexia. Analysis of cases of early postoperative complications showed that the classic Milligan-Morgan hemorrhoidectomy, compared with intraoperative laser coagulation, had a significantly higher frequency (p<0.001).

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