RU2821189C1 - Method of treating of chronic internal haemorrhoids of stages 2-4 - Google Patents

Abstract

FIELD: medicine; surgery.

SUBSTANCE: laser haemorrhoidoplasty is performed, followed by Doppler-controlled disarterization of haemorrhoids. When performing laser haemorrhoidoplasty, at a distance of 1 cm from the anoperineal junction, in the projection of the largest of the haemorrhoids, a 0.3 cm long perianal skin incision is made. A fibre optic probe with a cone-shaped tip is inserted through the tissue of the haemorrhoid parallel to the wall of the anal canal, and it is passed to the level of the projection vascular pedicle of the haemorrhoid. Using laser radiation with a wavelength of 1,470 nm and a power of 8 W, hemorrhoidal tissue located in the direction of the fibre optic probe is heated for three seconds. Then the probe is pulled up by 0.5 cm and shifted distally by 0.5 cm relative to the axis of the haemorrhoid, applying laser radiation, after which the fibre-optic probe is shifted in the opposite direction and the exposure is repeated. Then the probe is pulled up again by 0.5 cm and a similar effect is performed at three points located at a distance of 0.5 cm from each other, after which the fibre optic probe is removed from the wound. After this, Doppler-controlled disarterization of haemorrhoids is performed, for which, through a proctoscope with a hole in the side wall, under ultrasound Doppler navigation, the vascular pedicle of the haemorrhoid is sutured at 1 o’clock on the conventional dial with the formation of an 8-shaped suture with tying 5 simple knots, after which, by cutting the thread, sequential stitching of the rectal mucosa is performed in three rows. After forming three rows of stitches, the ends of the thread are tied with tension so that the stitched tissues are “gathered” in the form of a zone with a diameter of not more than 1 cm. Similar manipulations are performed on all the remaining haemorrhoids.

EFFECT: reduction of the risk of thread cutting in the postoperative period and reduction of the frequency of bleeding in the postoperative period, reduction of the risk of disease relapse.

1 cl, 7 dwg, 3 ex

Description

The invention relates to methods for surgical treatment of hemorrhoids and can be used in the treatment of patients with stage 2-4 hemorrhoids.

Hemorrhoids are one of the most common human diseases and remain the most common reason for visiting a coloproctologist. Its prevalence reaches 145 cases per 1000 adults, and its share in the structure of proctological diseases ranges from 34-41%, with equal occurrence in both men and women. The lifestyle of a modern person leads to stagnation of blood circulation in the pelvis and an increase in the incidence of hemorrhoids.

The operation of choice for decompensated stages of hemorrhoids remains open hemorrhoidectomy according to Milligan-Morgan in its various modifications, especially when hemorrhoids are combined with the presence of other diseases of the anal canal, such as an anal fissure or polyp.

Also widely used is closed hemorrhoidectomy - Fergusson's operation, which is one of the modifications of the previous technique, since hemorrhoidal collectors are removed in both cases in the radial direction, leaving mucocutaneous “bridges” between the surgical wounds. However, this intervention is not without its drawbacks, which include: 1) fairly intense pain in the postoperative period (in 23-41% of cases); 2) bleeding in the early postoperative period (from 2% to 4% of patients); 3) inflammatory complications (also in 2-4% of patients); 4) dysuria (in 15-26% of those operated on). All of the above significantly lengthens the recovery time after traditional hemorrhoidectomy.

Moreover, in the long term, postoperative strictures of the anal canal occur (occurring in 6-9% of cases) and at the same time - insufficiency of the anal sphincter (in 1.8-4% of patients). Moreover, relapses of hemorrhoidal disease in the long-term period after surgery (10-12 years) occur in 8.3-30% of patients who underwent hemorrhoidectomy.

In this situation, the interest of surgeons and coloproctologists in such a previously considered untenable intervention as the Whitehead operation (or its various modifications), including with a circular arrangement of hemorrhoids, as well as with the combination of chronic hemorrhoids of stages III-IV with other diseases of the anal canal, becomes understandable . This operation as a radical intervention is used in a modified modern form for the treatment of common forms of chronic hemorrhoids stage IV. There are reports of a combination of classical surgical interventions for hemorrhoids of stages III-IV with modern, minimally invasive techniques, such as desarterization, submucosal injections of sclerosants in combination with ultrasonic cavitation, submucosal diathermocoagulation of cavernous tissue.

Proctological surgeons have a large number of means of physical influence on the tissues of the anorectal region: electrosurgical devices, a plasma scalpel, an ultrasonic dissector, as well as various devices - emitters of quantum and thermal energy. Various publications, educational and methodological manuals cover all their advantages and disadvantages in sufficient detail.

In the scientific and technical literature, the number of reports on the use of minimally invasive treatment methods, incl. Laser coagulation for chronic internal hemorrhoids has recently increased. The high efficiency of transmucosal laser destruction of hemorrhoids with a minimum number of complications, when using the water-absorbing and hemo-absorbing part of the laser spectrum in an outpatient setting, is indicated in various reviews of specialized literature. The clinical effect of laser radiation is manifested in the normalization and improvement of microcirculation, a decrease in muscle tone, a decrease in the intensity of pain, relief of inflammatory processes, stimulation of reparative processes and immunity.

Intronodal laser coagulation (INLC) of internal hemorrhoids in the treatment of chronic hemorrhoids is one of the “youngest” methods used in minimally invasive proctology, and the prospects for its implementation are directly related to the development of laser equipment and widespread use in other branches of medicine.

The technique involves intranodal (submucosal) installation of a laser light guide into the tissue of the internal hemorrhoid, followed by its destruction without thermal damage to the mucous membrane and sphincter apparatus of the rectum. However, the success of treatment using this technology and the absence of complications depends on the modes of laser exposure and the technical characteristics of the laser light guides used.

State of the art

The closest to the method under consideration is the method of combined treatment of hemorrhoids, which is carried out by performing disarterization of hemorrhoidal arteries followed by submucosal destruction of hemorrhoids with a laser with a wavelength of 980 nm (RU 2620755, 05.29.2017; RU 2436537, 12.20.2011; KORNEV L.V. Combined minimally invasive treatment of hemorrhoids. Dissertation PhD, M., 2018).

However, unlike the one we propose, this method involves a different surgical technique, characterized by a higher level of trauma due to the use of a laser with a different wavelength and the use of an optical fiber with an end tip, which leads to a higher incidence of complications in the postoperative period.

The objective of the invention is to develop a method for effective treatment of stage 2-4 hemorrhoids on an outpatient basis, with minimal damaging effect on the mucous membrane of hemorrhoids and the internal sphincter.

The technical result of the claimed invention is the effective treatment of patients with stage 2-4 hemorrhoids by reducing the degree of surgical trauma, the time of operation, as well as increasing the level of safety of surgery by preheating the hemorrhoidal tissue using laser radiation until protein denaturation is achieved before performing disarterization of hemorrhoids, as well as due to lifting of the mucous membrane, performed in the form of a step-by-step application of multi-row sutures in a special way, which leads to a reduced risk of thread cutting in the postoperative period and a decrease in the frequency of bleeding in the postoperative period, in the case of the use of laser radiation before performing disarterization and lifting of hemorrhoids significantly reduces the risk of recurrence of hemorrhoids.

The achieved technical result is ensured by the developed method for the treatment of chronic internal hemorrhoids stages 2-4, including laser hemorrhoidoplasty with subsequent Doppler-controlled disarterization of hemorrhoids, characterized in that when performing laser hemorrhoidoplasty at a distance of 1 cm from the anoperineal junction, in the projection of the largest of the hemorrhoids nodes, a 0.3 cm long perianal skin incision is made, a fiber optic probe with a cone-shaped tip is inserted through the tissue of the hemorrhoid parallel to the wall of the anal canal, and it is passed to the level of the projection of the vascular pedicle of the hemorrhoid, using laser radiation with a wavelength of 1470 nm with a power of 8 W for three seconds, the tissues of the hemorrhoidal node located in the direction of the fiber optic probe are heated, then the probe is pulled up 0.5 cm and shifted distally by 0.5 cm relative to the axis of the hemorrhoidal node, subjected to laser radiation with a wavelength of 1470 nm and a power of 8 W for three seconds, after which the fiber optic probe is shifted to the side opposite to the axis of the hemorrhoidal node and the effect is repeated, then the probe is pulled up again by 0.5 cm and a similar effect is performed at three points located at a distance of 0.5 cm from each other, after why the fiber optic probe is removed from the wound;

then Doppler-controlled disarterization of hemorrhoidal nodes is performed, for which, through a proctoscope with a hole in the side wall, under ultrasound Doppler navigation, the vascular pedicle of the hemorrhoidal node is stitched at 1 o’clock on the conventional dial with the formation of an 8-shaped suture with tying 5 simple knots, after which, without cutting thread, sequential stitching of the rectal mucosa is performed in three rows: the first row is one stitch, 1 cm long, located perpendicular to the axis of the hemorrhoid, 0.5 cm below the 8-shaped seam, the second row is located 0.5 cm below the first row and consists of two similar stitches, symmetrical relative to the axis of the hemorrhoidal node, the third row is located 0.5 cm below the second row and represents 3 similar stitches;

after forming three rows of stitches, the ends of the thread are tied with tension so that the stitched fabrics are “gathered” in the form of a zone with a diameter of no more than 1 cm; similar manipulations are performed on all remaining hemorrhoids. List of figures:

Figure No. 1 - Formation of access for conducting optical laser fiber.

Figure No. 2 - Exposure to laser radiation in the projection area of the vascular pedicle of the hemorrhoid.

Figure No. 3 - Exposure to laser radiation in the second row after pulling up the probe.

Figure No. 4 - Ligation of the vascular pedicle of the hemorrhoid with an 8-shaped suture (1 stitch).

Figure No. 5 - Ligation of the vascular pedicle of the hemorrhoid with an 8-shaped suture (2 stitches).

Figure No. 6 - Tightening the ligature.

Figure No. 7 - Final view after applying the method.

Carrying out the invention

The patient is placed in a proctology chair, in the position for stone section, a Self light Sapimed anoscope with a working part diameter of 23 mm is installed in the anal canal, and the internal hemorrhoidal node is brought out into the anoscope. Before laser hemorrhoidoplasty, an anesthetic solution was injected under the node immediately above the dentate line (1% lidocaine solution 2.5 ml per 1 node or Articaine 4% Inibsa with epinephrine 1:100,000 - 1.8 ml per 1 node was used), after which at a distance of 1 cm from the anoperineal junction, in the projection of the largest of the hemorrhoids, a 0.3 cm long perianal skin incision was made (Fig. 1). A fiber optic probe with a cone-shaped tip is inserted through the tissue of the hemorrhoid parallel to the wall of the anal canal, and it is passed to the level of the projection of the vascular pedicle of the hemorrhoid.

Using laser radiation with a wavelength of 1470 nm and a power of 8 W, hemorrhoidal tissues located in the direction of the fiber optic probe with a deviation of 30° in each direction are heated for three seconds (Fig. 2). Then the probe is pulled up (pulled down from the wound) by 0.5 cm and shifted distally by 0.5 cm relative to the axis of the hemorrhoidal node, applying laser radiation, after which the fiber-optic probe is shifted to the side opposite to the axis of the hemorrhoidal node and the effect is repeated (Fig. 3). After this, the probe is pulled out of the wound by 0.5 cm and a similar effect is performed at three points located at a distance of 0.5 cm from each other, after which the fiber optic probe is removed from the wound.

The next stage is Doppler-controlled disarterization of hemorrhoids, for which, through a proctoscope with a hole in the side wall, under ultrasound Doppler navigation, the vascular pedicle of the hemorrhoid is sutured at 1 o’clock on the conventional dial, forming an 8-shaped suture, with tying 5 simple knots. After this, without cutting the thread, sequential stitching of the rectal mucosa is performed in three rows, with the first row consisting of one stitch, 1 cm long, located perpendicular to the axis of the hemorrhoid, 0.5 cm below the 8-shaped seam (Fig. 4), the second row - two similar stitches (Fig. 5), symmetrical relative to the axis of the hemorrhoid, located 0.5 cm below the first row, the third row - 3 similar stitches 0.5 cm below the second row.

After forming three rows of stitches, the ends of the thread are tied with tension so that the stitched fabrics are collected in the form of a zone with a diameter of no more than 1 cm (Fig. 6-7).

Similar manipulations are performed on all remaining hemorrhoids.

The positive result of using the method is achieved by the fact that when heating the hemorrhoidal tissue using laser radiation until protein denaturation is achieved before performing disarterization of hemorrhoids and lifting (mucopexy or tightening) of the mucosa, it leads to a decrease in the required volume of lifting of the mucosa, reducing the risk of thread cutting in the postoperative period and reducing the incidence of bleeding in the postoperative period. When using laser radiation before performing disarterization and lifting of hemorrhoids, the risk of re-development of hemorrhoids is reduced.

Examples

Example 1.

Patient N, 62 years old, complaints of bleeding after defecation, prolapse of internal hemorrhoids with self-reduction without manual assistance.

On examination: the skin of the perianal area is not changed, external hemorrhoids are not enlarged. The Valsalva maneuver is negative. A digital rectal examination reveals enlarged, swollen internal hemorrhoids at 3, 7, 11 o'clock, without signs of thrombosis, and a small amount of scarlet blood on the glove. Anoscopy reveals enlarged hemorrhoidal nodes of a purplish-bluish color, protruding into the lumen of the anoscope; the node is bleeding by contact at 7 o'clock. Rectosigmoidoscopy at a distance of up to 25 cm from the anal verge revealed no other pathology of the mucous membrane of the rectum and sigmoid colon. Colonoscopy did not reveal any other pathology of the rectum or colon.

Diagnosis: chronic internal hemorrhoids, stage 2.

Treatment was carried out according to the proposed method in the amount of laser submucosal plastic surgery of hemorrhoids at 3, 7, 11 o'clock of the conventional dial, followed by disarterization of hemorrhoids and lifting of the mucous membrane.

The early postoperative period proceeded without complications, the patient was discharged from the hospital on the 2nd day after surgery.

When re-examined 10 days after surgery: complaints of mild pain (2 points on the postoperative pain scale). Upon examination, there was no evidence of relapse of the disease. During a rectal digital examination, the hemorrhoidal nodes at 3, 7, 11 o'clock of the conventional dial were collapsed and compacted. The ligatures on the hemorrhoidal arteries are strong. Anoscopy was not performed to avoid damage to the ligatures.

Upon re-examination 30 days after surgery: no complaints. Upon examination, there was no evidence of relapse of the disease. During rectal digital examination, the hemorrhoids have collapsed, soft-elastic consistency, and are not differentiated against the background of healthy mucosa. In places where ligatures are formed, areas of scar tissue are identified; the scars are stable. During anoscopy, hemorrhoids are not visualized, do not prolapse into the lumen of the anoscope, whitish scars ranging in size from 0.5×0.5 cm to 0.5×1 cm are visually identified in places where ligatures are formed.

Upon re-examination 180 days after surgery: no complaints. Upon examination, there was no evidence of relapse of the disease. During rectal digital examination, hemorrhoids are not identified; in areas where ligatures are formed, there are areas of slight compaction (postoperative scars). During anoscopy, areas of scar tissue are visually identified that are slightly different in color from the healthy mucosa. In areas where ligatures are formed, areas of slight deformation of the rectal mucosa are determined.

When examined 2 years after surgery: no complaints. Upon examination, there was no evidence of relapse of the disease. During digital rectal examination, hemorrhoids are not identified. Anoscopy does not detect hemorrhoids. With rectosigmoidoscopy, the pathology of the mucous membrane of the rectum and sigmoid colon is not determined.

Example 2.

Patient N, 55 years old, complains of bleeding, worsening after defecation, prolapse of internal hemorrhoids with the need for their reduction using manual aid.

On examination: the skin of the perianal area is not changed, external hemorrhoids are not enlarged. The Valsalva test is positive, the nodes at 7 and 9 o'clock on the conventional dial prolapse from the anus when straining, do not reduce on their own, and the boundary between them is not visually determined. A digital rectal examination reveals enlarged, swollen internal hemorrhoids at 3, 7, 9, 11 o'clock, without signs of thrombosis, and scarlet blood on the glove. Anoscopy reveals enlarged hemorrhoidal nodes of a purplish color, protruding into the lumen of the anoscope; the nodes at 7 and 9 o’clock are bleeding from contact. Rectosigmoidoscopy at a distance of up to 25 cm from the anal verge revealed no other pathology of the mucous membrane of the rectum and sigmoid colon. Colonoscopy did not reveal any other pathology of the rectum or colon.

Diagnosis: chronic internal hemorrhoids stage 3.

Treatment was carried out according to the proposed method in the amount of laser submucosal plastic surgery of hemorrhoids at 3, 7, 9, 11 o'clock of the conventional dial, followed by disarterization of hemorrhoids and lifting of the mucous membrane.

The early postoperative period proceeded without complications, the patient was discharged from the hospital on the 3rd day after surgery.

Upon re-examination 10 days after surgery: complaints of moderate pain (5 points on the postoperative pain scale), relieved by oral administration of non-steroidal anti-inflammatory drugs. Upon examination, there was no evidence of relapse of the disease. During a rectal digital examination, the hemorrhoids at the 3, 7, 9, and 11 o'clock positions were collapsed and compacted. The ligatures on the hemorrhoidal arteries are strong. Anoscopy was not performed to avoid damage to the ligatures.

Upon re-examination 30 days after surgery: no complaints. Upon examination, there was no evidence of relapse of the disease. During a rectal digital examination, the hemorrhoids at 3 and 11 o'clock on the clock face are collapsed, have a soft elastic consistency, and are not differentiated against the background of healthy mucosa. The hemorrhoids at 7 and 9 o'clock on the conventional dial are collapsed and slightly compacted, compared to the previous examination and are smaller in size. In places where ligatures are formed, areas of scar tissue are identified; the scars are stable. During anoscopy, hemorrhoidal nodes at 3 and 11 o'clock are not visualized; in the places where the nodes are located at 7 and 9 o'clock, there is a section of mucous membrane deformed by ligatures. The nodes do not prolapse into the lumen of the anoscope; whitish scars, ranging in size from 0.5×0.5 cm to 1×1 cm, are visually identified in places where ligatures are formed.

Upon re-examination 180 days after surgery: no complaints. Upon examination, there was no evidence of relapse of the disease. During a rectal digital examination, hemorrhoidal nodes are not identified; in areas where ligatures are formed, there are areas of slight compaction (postoperative scars). During anoscopy, areas of scar tissue are visually identified that are slightly different in color from the healthy mucosa. In areas where ligatures are formed, areas of slight deformation of the rectal mucosa are identified.

When examined 2 years after surgery: no complaints. Upon examination, there was no evidence of relapse of the disease. During digital rectal examination, hemorrhoids are not identified. Anoscopy does not detect hemorrhoids. With rectosigmoidoscopy, the pathology of the mucous membrane of the rectum and sigmoid colon is not determined.

Example 3.

Patient N, 67 years old, complains of daily bleeding during defecation, constant prolapse of internal hemorrhoids with the impossibility of their reduction using manual aid.

On examination: the skin of the perianal area is not changed, enlarged, cyanotic internal hemorrhoids prolapse from the anus at 3, 5, 7 o'clock on the conventional dial, are bleeding from contact, and cannot be reduced. During the Valsalva maneuver, the nodes fall out of the anus at 1, 9, 11 o'clock and do not retract on their own. The border between internal and external hemorrhoids at 3, 5, 7 o'clock is not differentiated. A digital rectal examination reveals enlarged, swollen internal hemorrhoids at 1, 3, 5, 7, 9 and 11 o'clock on the dial, without signs of thrombosis, and scarlet blood on the glove. During anoscopy at 1, 9, 11 o'clock on the conventional dial, enlarged hemorrhoidal nodes of a bluish color are detected, protruding into the lumen of the anoscope; nodes at 3, 5 and 7 o'clock are contact bleeding. Rectosigmoidoscopy at a distance of up to 25 cm from the anal verge revealed no other pathology of the mucous membrane of the rectum and sigmoid colon. Colonoscopy did not reveal any other pathology of the rectum or colon.

Diagnosis: chronic external and internal hemorrhoids, stage 4.

Treatment was carried out according to the proposed method in the amount of laser submucosal plastic surgery of hemorrhoids at 1, 3, 5, 7, 9, 11 hours of the conventional dial, followed by disarterization of hemorrhoids and lifting of the mucous membrane.

The early postoperative period proceeded without complications, the patient was discharged from the hospital on the 5th day after surgery.

Upon re-examination 10 days after surgery: complaints of moderate pain (4 points on the postoperative pain scale), relieved by oral administration of non-steroidal anti-inflammatory drugs. Upon examination, there was no evidence of relapse of the disease. Hemorrhoidal nodes at 3, 5, 7 o'clock of the conventional dial are collapsed, without signs of inflammation and thrombosis. During a rectal digital examination, the hemorrhoids at 1, 3, 5, 7, 9, 11 o'clock on the dial were collapsed and compacted. The ligatures on the hemorrhoidal arteries are strong. Anoscopy was not performed to avoid damage to the ligatures.

Upon re-examination 30 days after surgery: no complaints. Upon examination, there was no evidence of relapse of the disease. The external nodes are collapsed, without signs of inflammation and thrombosis, and are smaller in size compared to the previous examination. During rectal digital examination, the hemorrhoids at 1, 9, 11 o'clock of the conventional dial are collapsed, soft-elastic in consistency, and are not differentiated against the background of healthy mucosa. The hemorrhoids at 3, 5, 7 o'clock on the conventional dial are collapsed and slightly compacted, compared to the previous examination and are smaller in size. In places where ligatures are formed, areas of scar tissue are identified; the scars are stable. During anoscopy, hemorrhoidal nodes at 1, 9, 11 o'clock are not visualized; in the places where the nodes are located at 3, 5, 7 o'clock there is a section of the mucous membrane deformed by ligatures. The nodes do not prolapse into the lumen of the anoscope; in places where ligatures are formed, whitish scars ranging in size from 0.5×0.5 cm to 1×1.5 cm are visually identified.

Upon re-examination 180 days after surgery: no complaints. Upon examination, there was no evidence of relapse of the disease. During rectal digital examination, hemorrhoids are not identified; in areas where ligatures are formed, there are areas of slight compaction (postoperative scars). During anoscopy, areas of scar tissue are visually identified that are slightly different in color from the healthy mucosa. In areas where ligatures are formed, areas of slight deformation of the rectal mucosa are determined.

When examined 2 years after surgery: no complaints. Upon examination, there was no evidence of relapse of the disease. During digital rectal examination, hemorrhoids are not identified. Anoscopy does not detect hemorrhoids. With rectosigmoidoscopy, the pathology of the mucous membrane of the rectum and sigmoid colon is not determined.

A similar method was used to treat 214 patients with stage 2 chronic internal hemorrhoids. In the early postoperative period, 6 patients (3%) developed bleeding; in all cases, the surgical area was revised and the bleeding was stopped. A relapse-free course was observed in 206 patients (96%), recurrent bleeding within 2 years was observed in 7 patients (3%), relapse of prolapse developed in 1 patient (less than 1%). No other complications were noted.

Also, 172 patients with stage 3 chronic internal hemorrhoids were treated. In the early postoperative period, 7 patients (4%) developed bleeding; in all cases, the surgical area was revised and the bleeding was stopped. A relapse-free course was observed in 160 patients (93%), recurrent bleeding within 2 years was observed in 7 patients (4%), relapse of prolapse developed in 5 patients (3%). No other complications were noted.

103 patients with chronic internal and combined hemorrhoids of stage 4 were treated. In the early postoperative period, bleeding developed in 5 patients (5%), in 4 cases the surgical site was revised and bleeding was stopped, and one patient underwent hemorrhoidectomy (1%). A relapse-free course was observed in 89 patients (86%), recurrent bleeding within 2 years was observed in 7 patients (7%), relapse of prolapse developed in 7 patients (7%), which required repeated surgical intervention. No other complications were noted.

Claims (1)

A method for the treatment of chronic internal hemorrhoids of stages 2-4, including laser hemorrhoidoplasty followed by Doppler-controlled disarterization of hemorrhoids, characterized in that when performing laser hemorrhoidoplasty at a distance of 1 cm from the anoperineal junction, in the projection of the largest of the hemorrhoids, an incision of the perianal skin is made with a length 0.3 cm, a fiber optic probe with a cone-shaped tip is inserted through the tissue of the hemorrhoid parallel to the wall of the anal canal, and it is passed to the level of the projection of the vascular pedicle of the hemorrhoid; using laser radiation with a wavelength of 1470 nm with a power of 8 W, tissue is heated for three seconds hemorrhoidal node, located in the direction of the fiber optic probe with a deviation of 30° in each direction, then the probe is pulled up 0.5 cm and shifted distally by 0.5 cm relative to the axis of the hemorrhoidal node, exposed to laser radiation with a wavelength of 1470 nm with a power of 8 W for three seconds, after which the fiber-optic probe is shifted in the opposite direction and the impact is repeated, then the probe is pulled up again by 0.5 cm and a similar impact is performed at three points located at a distance of 0.5 cm from each other, after which the fiber-optic probe is removed from the wound; then Doppler-controlled disarterization of hemorrhoids is performed, for which, through a proctoscope with a hole in the side wall, under ultrasonic Doppler navigation, the vascular pedicle of the hemorrhoid is sutured at 1 o’clock on the conventional dial, forming an 8-shaped suture with tying 5 simple knots, after whereby, without cutting the thread, sequential stitching of the rectal mucosa is performed in three rows: the first row is one stitch, 1 cm long, located perpendicular to the axis of the hemorrhoid, 0.5 cm below the 8-shaped seam, the second row is placed on 0.5 cm below the first row and consists of two similar stitches, symmetrical relative to the axis of the hemorrhoidal node, the third row is placed 0.5 cm below the second row and represents 3 similar stitches; after forming three rows of stitches, the ends of the thread are tied with tension so that the stitched fabrics are “gathered” in the form of a zone with a diameter of no more than 1 cm; similar manipulations are performed on all remaining hemorrhoids.