RU2408290C2 - Method and device for surgical treatment of rectal and hemorrhoidal prolapse - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to surgery. Method of performing surgical operations on rectal and hemorrhoidal prolapse includes application in anal canal of first circular stitch on the first section of hemorrhoidal prolapse, application of second circular stitch on the second section of hemorrhoidal prolapse. After that, first and second circular stitches are tightened in order to obtain constriction of hemorrhoidal prolapse. Device for realisation of said method includes hollow divaricator which is installed into patient's anal orifice. Divaricator is made in prevailing direction along longitudinal axis. Device has a window. The window forms working zone and ensures communication between internal cavity of divaricator and section of hemorrhoidal prolapse. Device additionally has means serving for opening and closing of the window.

EFFECT: created is method and device for surgical operations on rectal and hemorrhoidal prolapse, which in short time reduce size of hemorrhoidal prolapse inside anal canal.

19 cl, 7 dwg

Description

FIELD OF TECHNOLOGY

The invention relates to a method and devices (options) for the surgical treatment of hemorrhoidal prolapse.

The scope of the invention relates to surgical operations associated with proctological pathologies, in particular, aimed at treating and / or reducing the size of hemorrhoidal prolapse.

BACKGROUND OF THE INVENTION

It is known that the development of hemorrhoidal manifestations is caused by pathological disorders in the sinuses of the anal canal, formed by vascular spaces, arteriovenous anastomoses and sac-like venous structures that make up the internal hemorrhoid plexus. More specifically, the internal hemorrhoid plexuses are blood-filled areas of a few millimeters in size, limited to venous or capillary endothelium inside the connective tissue, covered with rectal mucosa. These structures are supported by attaching to the internal sphincter fibers of muscle tissue, which form Parks ligaments.

The flow of arterial blood to the sinuses occurs only from the terminal branches of the superior rectal artery, and this feature has led to treatment methods that have been introduced into the latest treatment programs.

Surgical technologies are constantly evolving in this area, where you can try to make these operations as traumatic as possible, especially in light of the prior art, often leading to serious threats and complications for patients who undergo such operations.

The main surgical methods, especially in the past, were based on the removal of tissues, that is, the surgical removal of sections of the rectal mucosa affected by pathology.

This type of procedure involves the removal of hemorrhoidal prolapses and the suturing of the affected areas.

This type of procedure is described in detail in the international publication WO 01/21060, which presents a set of auxiliary medical instruments for transanal operations and the method of its use.

More specifically, this method involves manipulating the mucous membrane of the rectal wall, mainly in the area of the mucous membrane affected by hemorrhoidal prolapse, with the creation of a ring or annular structure similar to a pouch. Several times perform a circular suture with suture, until it covers the entire prolapse along the peripheral growth of the rectal ampoule, performing ring extrusion of the prolapse into the rectal ampoule.

Then, the annular extrusion performed in this way is excised, while suturing the remaining edges of the mucous membrane collected in the bundle.

The device used to implement this method has a semi-cylindrical body connected to the handle-grip and inserted into the anus of the patient, for example, using an introducer of a cone-shaped anatomical shape. At the front end of the semi-cylindrical body there is an opening that overlaps part of the hemorrhoidal prolapse and allows its extrusion into the body. The device further comprises a mechanical suturing device, used after the introduction of a semi-cylindrical body, designed to cut ring extrusion using a cylindrical blade and suturing the edges of the remaining part of the mucous membrane, driving metal clips inside the edges of the fabric.

Obviously, this procedure is very traumatic.

In particular, despite the good results and the complete absence of relapses, the procedure causes postoperative pain and requires the patient to stay in the hospital, and, in addition, can cause postoperative complications and risks inherent in invasive operations.

Among other things, scientific studies of various exposure techniques, known as parasurgical technologies, aimed at eliminating the serious shortcomings of traditional surgery, have been carried out. These technologies include, for example, latex ligation of hemorrhoidal tissue, squeezing of the hemorrhoidal node at the point of attachment to the mucous membrane of the rectal canal using elastic ligature and cause its physiological collapse without resorting to resection of hemorrhoidal tissue. Another example of parasurgical technology is sclerotherapy, which causes necrosis of the affected area by introducing a sclerotherapy solution.

The following examples of parasurgical technologies are infrared coagulation, cryotherapy and laser therapy.

Some of these parasurgical treatments suggest the use of a device as described in international publication WO 2004/064624. This device comprises a cylindrical body, functioning as a divaricator, having a grip and an opening made laterally for intercepting and monitoring a site of hemorrhoidal prolapse. Near the opening in the body there is a mounting place for a probe (in particular, an ultrasound probe) capable of detecting the proximity of a blood vessel in order to be able to directly intervene accurately in the area of actual lesion with hemorrhoidal prolapse, even in case of insufficient visibility and / or access to the area . The device further comprises illumination means connected to the grip and used to illuminate the area subject to surgical intervention and, if necessary, to emit light into the cylindrical body. In particular, a device of the type described above is used to create surgical clamping in the terminal part of the superior rectal artery covered by hemorrhoidal prolapse by applying a ligature in the area surrounding the artery (using a curved suture needle), leading to clamping of the area and causing collapse due to the cessation of blood flow.

However, this technique alone cannot reduce the size of hemorrhoidal prolapse within the anal canal in a short time.

Thus, the technical task of this invention is to provide a method and device for surgical operations in hemorrhoidal prolapse, which eliminate the above disadvantages.

The main objective of this invention is to create a method and device for surgical operations in hemorrhoidal prolapse, which in a short time reduces the size of hemorrhoidal prolapses inside the anal canal.

The next objective of this invention is to create a method and device for surgical operations in hemorrhoidal prolapse, which can reduce postoperative complications and postoperative pain.

Another objective of this invention is to provide a method and device for surgical operations in hemorrhoidal prolapse, which limit the need for the patient to use painkillers or which in any case limit the need for anesthesia as much as possible.

These and other tasks are essentially achieved by using the method and device for surgical operations in hemorrhoidal prolapse, performed in accordance with the attached claims.

DETAILED DESCRIPTION OF THE INVENTION

The following is a non-exclusive and non-limiting example that describes the preferred embodiment of the method and device for surgical operations for hemorrhoidal prolapse with reference to the accompanying drawings, in which:

figure 1 is a schematic view of the anal canal in longitudinal section;

figure 2 is a side view of the proposed device;

figure 3 is a perspective view of the first part of the device shown in figure 2;

figure 4 is a top view of the first part of the device shown in figure 2;

figure 5 is a cross section of the first part of the device shown in figure 2;

Fig.6 is a side view of the second part of the device shown in Fig.2;

Fig.7 is a perspective view of the second part of the device shown in Fig.2.

A preferred embodiment of the invention of a method and device for surgical operations in hemorrhoidal prolapse includes the following steps:

- performing at least a first circular stitch 1 at the site of hemorrhoidal prolapse 2 using, for example, suture thread 6;

- performing at least a second circular stitch 4 in the same place, that is, in hemorrhoidal prolapse 2;

- tightening the first and second circular stitches 1 and 4 for hauling hemorrhoidal prolapse 2.

Advantageously, the application of the first stitch 1 and the second stitch 4 is performed, respectively, in the first section 2a and the second section 2b of the hemorrhoidal prolapse 2, which, as shown in Fig. 1, is located near the final section of the muscle bundle of the rectum 5 and develops in the prevailing direction X. Moreover, the first prolapse portion 2a 2a is located deeper inside the rectum 5 compared to portion 2b. This provides particular advantages that will become more apparent from the description below.

The application of circular stitches is performed using various suture elements.

In the embodiment of FIG. 1, the depicted yarn 6 is preferred, which will be referred to as suture 6 hereinafter.

Suture 6 is wound several times around hemorrhoidal prolapse 2, which protrudes from the wall 7 of the rectum 5 in the direction of its internal space and in the direction of the anal opening 8 of the rectum 5. In the schematic image shown in Fig. 1, the loop 6 partially passes into the tissues , which make up the wall 7 of the rectum 5, and, in particular, inside the tissues forming the hemorrhoidal prolapse 2. The insertion of the thread 6 into the tissue is preferably performed using a sharp object, such as a needle, which is not shown in Mr. document, as it is well known.

Preferably, the first step of the first circular stitch 1 is performed by introducing the first end 9 of the thread 6 into the first portion 2a of the hemorrhoidal prolapse 2. The application of the second circular stitch 4, preferably using the same suture thread 6, is performed in the same way, introducing the first end 9 of the thread 6 into the second plot 2b of hemorrhoidal prolapse 2. In this configuration, which is shown in FIG. 1, the first end 9 of the thread 6 refers to the second stitch 4, while the second free end 10 of the thread refers to the first stitch 1. The above method involves Use on the first end of thread 6 of a curved needle.

The step of applying the first circular stitch 1 mainly also includes the stage of applying additional circular stitches 11. Additional stitches 11 impose on the third section 12 of hemorrhoidal prolapse 2, located between the first section 2A and the second section 2b. Figure 1 shows two additional stitches 11 located in intermediate positions between the first stitch 1 and the second stitch 4. Stitches 1, 4, 11 are preferably superimposed using one suture thread 6.

Moreover, each stitch 1, 4, 11 of thread 6 mainly affects the terminal branch of the rectal artery 13, related to hemorrhoidal prolapse 2, therefore, subsequently, the terminal branch can be clamped following the procedure described later in this document.

In particular, a curved needle is taken and punctured into the tissue of hemorrhoidal prolapse 2, which encircles the terminal branch of the rectal artery 13, so that as a result, when the curved needle comes back from the tissues, a loop is formed inside which the aforementioned terminal branch of the rectal artery 13 is located. Thus, each step of making stitches 1, 4, 11 includes the stage of applying at least one loop that engages the final branch of the rectal artery 13 subjected to proctological pathology.

In a preferred embodiment of the method of the invention illustrated in FIG. 1, each loop is in a plane that is perpendicular to the direction X of the prevailing growth of hemorrhoidal prolapse 2. This is advantageous since each step of applying stitches 1, 4, 11 also includes the step of pulling the corresponding stitch 1 , 4, 11. Each individual finished loop is now tightened, preferably manually pulling suture thread 6. Due to the above arrangement of the individual loops, tightening is performed tsya much easier, because an exceptionally transverse constriction on the progress of the rectal artery 13, without causing alterations in an axial direction.

Stretching of suture 6 is intended to constrain a portion of hemorrhoidal prolapse 2 (and thus the corresponding bundle of rectal artery 13), captured by a separate loop, and leads to the termination of blood flow in this bundle, causing its collapse.

The steps of applying stitches 1, 4, 11 are preferably performed by applying them in substantially overlapping positions along the X direction of the prevailing growth of hemorrhoidal prolapse 2. This leads to the formation of an ordered sequence of loops according to the configuration shown in figure 1, in which a group of individual loops directionally covers hemorrhoidal prolapse 2.

After completing the steps of applying stitches 1, 4, 11, it is predominantly assumed that the first stitch 1 and the second stitch 4 move closer together to constrain the hemorrhoidal prolapse 2, also along the direction X of its prevailing growth. Thus, a significant decrease in the total size of hemorrhoidal prolapse 2 within the rectum 5 is achieved.

The step of approaching the stitches 1, 4 is preferably performed using the step of tying the suture thread 6. The step of tying includes the step of performing one or more consecutive nodes that fix the previous approach of the stitches 1, 4.

Moreover, the method according to the invention can advantageously include the step of completing an additional circular stitch, in particular a “basic circular stitch”, partially shown in FIG. 1 and indicated by position number 14, which serves as a signal for ending the thread 6.

This step, preferably performed before the application of the first circular stitch 1, is performed by forming at least one loop on that portion of the wall of the rectum 5 that is not covered by hemorrhoidal prolapse 2. The basic circular stitch 14 is intended to create a latch for the next approach step stitches 1, 4, which will be explained in more detail later in this document.

In addition, it is preferable that the base circular stitch 14 was made using suture 6 used to sew stitches 1, 4, 11. Moreover, the base stitch 14 is preferably performed on the section of the rectum 5 located deeper than hemorrhoidal prolapse 2, relative to the anus 8 and, thus, at a higher location, as shown in figure 1. Therefore, based on the previously adopted arrangement of the first stitch 1 and the second stitch 4 previously established in this document, the base stitch 14 is also located deeper than the first stitch 1.

In more detail, at the initial stage, the second end 10 of the suture 6, relating to the first stitch 1, and thus located in place of the base stitch 14, is partially bent to form a gap, indicated by the position number 15 in figure 1 . The first end 9 of the suture thread 6 can be inserted inside the slit 15 and begin the step of approaching the stitches 1, 4 by pulling the suture thread 6; then you can start the knitting step, which fixes the position of the convergence of circular stitches.

In addition, at the above stages, in which haemorrhoidal prolapse 2 is constricted, the specified prolapse is lifted in the direction of the base stitch 14 and into the anal canal 5 (the right constriction and elevation of the treated hemorrhoidal node 2 are illustrated on the right side of FIG. 1). This helps to remove hemorrhoidal prolapse 2 from the anus 8, reduce its size inside the rectum 5, as well as the correct location of the soft tissues of the anal canal above the threshold of pain sensitivity.

Thus, the base stitch 14 acts as a fulcrum towards which hemorrhoidal prolapse 2 is pulled up and then covered with stitches 1, 4, 11 in order to form a prolapse constriction 2 and reduce its size inside the rectum 5.

The proposed method is applicable to operations performed with hemorrhoidal prolapses of various types and forms, and, summarizing the above, can be characterized as including the execution of circular stitches that can bind hemorrhoidal prolapse and the rectal artery covered by it, preferably using one suture thread and performing at least at least one basic circular stitch made on that section of the wall of the rectal canal that is not susceptible to hemorrhoidal pathologies.

The following is a description of a device for surgical operations in hemorrhoidal prolapse, preferably, but not necessarily used in the implementation of the above method.

The device, indicated by the position number 16, contains a hollow divator 17 having a cylindrical central part 17a, in which a cavity 17b is provided, which is the zone of introduction of the device. The central part 17a is connected to the closed front part 17c, which is preferably conical in shape so that it can be inserted into the patient's anus, minimizing unpleasant sensations for the patient. In addition, the divaricator 17 comprises a truncated cone-shaped rear part 17d having a larger transverse dimension in order to maximize the penetration of the divaricator 17 into the anus. The back part 17d is also hollow in order to provide access for the surgeon to the cavity 17b during surgery, from the rear end 17e according to the direction of insertion of the divaricator 17 into the anus.

The device 16 further comprises a first half-shell 18, tightly attached to the rear 17d of the divaricator 17, forming a handle portion of the device 16. Preferably, with the help of two parts 19, 20, the first half-shell 18 is connected to the second half-shell 21, which completes the formation of the handle of the device 16 In this configuration, the handle forms the first place 22 for installing the lighting means 23 in the area between the two half-shells 18, 19.

The lighting means 23 is preferably made with optical fiber 24. For example, the optical fiber 24 is inserted into the free end of the handle, pushed into the first mounting position 22 until it reaches a working position in which it emits light that can penetrate into the depth of the divator 17 for work area lighting (indirect lighting).

Preferably, a window 29 is provided on the lateral portion of the divaricator 17, which indicates the area of operation and establishes a message between the cavity 17b and, therefore, the surgical instrument located inside the cavity and the rectal wall when the device 16 is inserted inside. Window 29 facilitates access to the hemorrhoidal prolapse located on the rectal wall.

The window 29 has at least a first portion 29a formed between the central portion 17a and the front portion 17c. In the preferred embodiment shown in FIGS. 2 and 3, the first section 29a of the window 29 extends predominantly across the longitudinal axis Z, along which the longitudinal axis Z of the divaricator 17 extends predominantly. In the illustrated embodiment, the first section 29a of the window 29 is rectangular.

Near the first portion 29a of window 29, the front portion 17 of the divaricator 17 preferably has a cone 30 designed to further facilitate the penetration of the divaricator 17 into the anus, while hemorrhoidal prolapse in the window 29 enters the cone 30.

The window 29 preferably has an adjustable length, preferably in a direction parallel to the longitudinal axis Z of the divaricator 17. This extension is obtained by means of opening and closing means 31 of the window 29, the meaning of which will be explained later.

The window 29 advantageously has a second portion 29b, preferably adjacent to the first portion 29a. In a preferred embodiment, the first portion 29a and the second portion 29b communicate and thereby form a single window 29. Moreover, the second portion 29b of the window 29 is formed along the longitudinal axis Z of the divaricator 17 and preferably extends from the first portion 29a to the rear end 17e of the divaricator 17 The second portion 29b may have any transverse dimension, preferably less than or equal to the transverse dimension of the first portion 29a.

The window opening and closing means 31 is preferably made using a movable wall 32. The movable wall 32 is slidably mounted on the second portion 29b of the window 29, for example, by means of sliding guides 32a and can assume operating positions between the closed position in which it completely blocks the second a window portion 29b, leaving only the first portion 29a accessible, and in an open position in which it fully opens the second portion 29b of the window 29, which is thus fully open and sleep accessible guns. The movable wall 32 is moved between the closed and open positions by sliding in the direction of the rear end 17e of the divariator 17. Elongation of the window in the longitudinal direction, as described above, is advantageous, especially if rectal artery surgery is performed using ligature.

In the preferred embodiment shown in the accompanying drawings, the movable wall 32 only interacts with the second portion 29b of the window 29, while the first portion 29a is accessible from the outside, even if the movable wall 32 is in the closed position.

In order for the surgeon to easily grab the movable wall 32, this wall may additionally have a special device that serves to capture it. However, in the presently preferred embodiment, the movable wall 32 has a shape opposite to that of the second portion 29b of the window 29 with which it is in contact, therefore, in the closed position, the movable wall 32 does not protrude forward with respect to the translational movement of the surface of the divaricator 17.

The device 16 also has sensors, not shown in the drawings, designed to detect pulsation of a vein or artery, in particular, to detect the proximity of the rectal artery. The sensors are preferably ultrasound probes and can advantageously be located on the movable wall 32, preferably detachably, in order to constantly monitor the proximity of the rectal artery even during the sliding movement of the movable wall 32.

To accommodate the sensors, the wall 32 has a special mounting position 33 facing the outer surface of the wall 32 and, therefore, the divaricator 17 through the outer terminal hole 33a provided on the movable wall 32. The outer hole 33a, in which the mounting place 33 is in communication with the outer surface divaricator 17, helps to detect the rectal artery using sensors, leading them to the wall of the rectum and placing them in direct contact with hemorrhoidal prolapse, so that they can Detect the proximity of an artery by registering the appropriate blood flow. In addition, the mounting location 33 is preferably in communication with the cavity 17b of the divaricator, allowing sensors to be inserted inside the mounting location 33 through the rear end 17e of the divaricator 17.

Inside the cavity 17b there is a guide device 34 which is attached to the divaricator 17 and is intended to guide the surgical instrument during use, that is, at the stage of the operation. More specifically, the guiding device 34 is a hole support 35, preferably located near the first portion 29a of the window 29. Moreover, the support 35 with the hole is not fixed in a central position near the first portion 29a of the window 29. In addition, the support 35 is fixed not in a central position relative to the longitudinal Z axis of the divaricator 17, in particular in the direction of the window 29. This is very advantageous for operations on arteries using ligatures, in which a curved needle is fixed in the holder and ly, describes a circular path, thus, needle, partially exiting divarikatora 17 through the window 29, bandages affected hemorrhoidal artery, previously detected by the ultrasound probe. A circular path is obtained by providing rotation of the needle holder, while the front end of the holder is inside the support 35 with the hole.

In order to have a real-time representation of the depth of penetration of the divaricator 17 into the anus, outside of the divaricator 17, at least on its central part 17a, there can be one or more easily distinguishable scale marks 36, which can be, for example, protruding embossed marks.

The invention provides significant advantages.

Firstly, the described method quickly reduces hemorrhoidal prolapse, eliminating the need for painful surgical operations.

Further, the method involves less dependence on anesthesia compared to traditional procedures.

Among the advantages of the method, the first and most significant advantage is the excellent results obtained when it is used in hemorrhoidal pathologies while maintaining the vascular state of the soft tissues, which is important in regulating the function of defecation.

A further advantage stems from the fact that by attaching a hemorrhoidal prolapse to the base circular stitch, the method allows the soft tissue of the anal canal to be set again above the pain threshold, thereby eliminating hemorrhoidal prolapse.

Regarding the above-described device, an important advantage stems from the presence of a movable wall made with the possibility of extension, which preferably in the case of operations on vessels using a ligature helps to change the area of operation even without partial removal of the divaricator, which is a particularly time-consuming task for the surgeon.

Moreover, the mounting of the sensor on a movable wall makes it possible to constantly monitor the proximity of the affected rectal artery without moving the device, if this is not particularly necessary.

And finally, the special geometry of the moving wall does not have any protrusion that can cause discomfort or pain to the patient; moreover, the precise and physiological shape of the wall meets the requirement of a low level of patient injury.

Claims (19)

1. A method of performing surgical operations with hemorrhoidal prolapse, comprising the steps of:
performing at least a first circular stitch (1) in the rectum of the patient, which is performed on the first section (2A) of hemorrhoidal prolapse (2),
of at least a second circular stitch (4) in the second portion (2b) of hemorrhoidal prolapse (2), each step of stitching (1, 4) includes the step of applying at least one loop, inside of which there is the aforementioned terminal branch of the rectal artery (13), and
constriction of the first circular stitch (1) and the second circular stitch (4) for constricting hemorrhoidal prolapse (2), while before the step of at least the first circular stitch (I), the step of at least basic circular stitch (14) is carried out in the section rectal wall, which is located more deeply relative to the anus (8) compared with hemorrhoidal prolapse (2) and which is not affected by hemorrhoidal prolapse (2), for fixing the tightened circular stitches (1, 4), and at the stage of tying the suture (6) ) by unravels circular stitching (1, 4) in the direction of the circular stitch base (14). 2. The method according to claim 1, in which additional circular stitches (11) are performed on the hemorrhoidal prolapse sections (2) located between the first section (2a) and the second section (2b). 3. The method according to claim 1 or 2, in which at the steps of making circular stitches (1, 4) at least a loop is arranged located in a plane perpendicular to the direction (X) of the prevailing growth of hemorrhoidal prolapse (2). 4. The method according to claim 1, in which the steps of making circular stitches (1, 4) are carried out by making circular stitches (1, 4) overlapping each other along the direction (X) of the prevailing growth of hemorrhoidal prolapse (2). 5. The method according to claim 1, in which the execution of circular stitches (1, 4) is carried out using one suture thread (6). 6. The method according to claim 5, in which at the stage of tightening the circular stitches (1, 4), a suture thread (6) is tied to form a stable, tightened position of the circular stitches (1, 4). 7. The method according to claim 1, in which at each stage of the execution of circular stitches (1, 4) tighten these stitches. 8. The method according to claim 6, in which the first end (9) of the suture thread (6) refers to the second circular stitch (4), while in the step of tying the suture thread (6), the first end (9) of the suture thread (6) is introduced inside the basic circular stitch (14). 9. A device for surgical operations in hemorrhoidal prolapse containing a hollow divaricator (17), structurally made in the prevailing direction along the longitudinal axis (Z) and inserted into the anus, while the divaricator (17) has a window (29) that limits the working area and providing communication between the internal cavity (17b) of the divaricator (17) and the hemorrhoidal prolapse portion, the device comprising means (31) for opening and closing the window (29) to facilitate changing the operation zone, said means (31) opening tearing and closing the window (29) contains a movable wall (32) made with the possibility of moving from a closed position to an open position by sliding movement of the specified movable wall (32) in the direction of the rear end (17e) of the divaricator (17),
characterized in that the window (29) has a first section (29a) extending predominantly across the longitudinal axis (Z) and a second section (29b) extending parallel to the longitudinal axis (Z), wherein the movable wall (32) functions in the second section ( 29b) windows (29) for opening or closing it. 10. The device according to claim 9, in which the first section (29a) of the window (29) has a rectangular shape. 11. The device according to claim 9, in which said first section (29a) and the second section (29b) communicate and form a single window (29). 12. The device according to claim 11, in which the second section (29b) of the window (29) extends from the first section (29a) of the window (29) to the rear end (17e) of the divaricator (17), while the rear end (17e) is determined according to the direction of introduction of the divaricator (17) into the anus. 13. The device according to claim 9, in which the movable wall (32) is slidably mounted on the second section (29b) of the window (29) and can take working positions between the closed position, in which the movable wall (32) completely blocks the second section ( 29b) of the window (29), leaving only the first portion (29a) of the window (29) accessible, and the open position in which the movable wall (32) fully opens the second portion (29b) of the window (29), which is thus fully open and is accessible from the outside. 14. The device according to item 13, in which the movable wall (32) interacts only with the second section (29b) of the window (29), while the first section (29a) of the window (29) is accessible from the outside, even if the movable wall (32) is in the closed position. 15. A device for surgical operations in hemorrhoidal prolapse containing a hollow divaricator (17), structurally made in the prevailing direction along the longitudinal axis (Z) and inserted into the anus, while the divaricator (17) has a window (29) having a first section ( 29a) and a second section (29b) extending parallel to the longitudinal axis (Z), limiting the working area and providing communication between the internal cavity (17b) of the divaricator (17) and the hemorrhoidal prolapse section, the device comprising means (31) for opening and closing closing the window (29) to facilitate changing the zone of operation, and the specified means (31) for opening and closing the window (29) contains a movable wall (32), functioning in the second section (29b) of the window (29) to open or close, and movable the wall (32) has the form opposite to the second section (29b) of the window (29) with which it is in contact, therefore, in the closed position, the movable wall (32) does not protrude forward relative to the translational motion of the surface of the divaricator (17), characterized in that the movable wall (32) is installed with the possibility of sliding in the second section (29b) of the window (29) and can take working positions between the closed position in which the movable wall (32) completely blocks the second section (29b) of the window (29), leaving only the first section (29a) of the window ( 29), and an open position in which the movable wall (32) completely opens the second portion (29b) of the window (29), which is thus fully open and accessible from the outside. 16. A device for surgical operations in hemorrhoidal prolapse containing a hollow divaricator (17), structurally made in the prevailing direction along the longitudinal axis (Z) and inserted into the anus, while the divaricator (17) has a window (29) that limits the working area and providing communication between the internal cavity (17b) of the divaricator (17) and the hemorrhoidal prolapse portion, the device comprising means (31) for opening and closing the window (29) to facilitate changing the operation zone, said means (31) from tearing and closing the window (29) contains at least a movable wall (32), slidingly connected with a divaricator (17) and functionally acting on the window (29), characterized in that the movable wall (32) has a socket (33) for installation of sensors used to detect the proximity of the hemorrhoidal artery with the possibility of their removal. 17. The device according to clause 16, in which the movable wall (32) has an external terminal hole (33 a), designed to bring the sensor to the hemorrhoidal artery. 18. The device according to clause 16, in which the socket (33) made in the movable wall (32) communicates with the cavity (17b) of the divaricator (17) to facilitate the insertion and fixation of the sensors on the movable wall (32), operating directly from the cavity (17b). 19. The device according to clause 16, further comprising sensors designed to record the proximity of the rectal artery, and these sensors are located on the movable wall (32) with the possibility of disconnection.

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