PPH is a minimally invasive procedure, also known as supra-hemorrhoidal circumferential hemorrhoidectomy, which is a new technique based on a new understanding of the pathogenesis of hemorrhoids caused by anal cushion lesions. The PPH procedure is a circular excision of the prolapsed rectal mucosa above the hemorrhoid. The PPH procedure is performed by circumferential excision of the prolapsed rectal mucosa above the hemorrhoid. During the operation, the anus is opened and the rectal mucosa is sutured in a loop about 4 cm above the dentate line (the junction line between the rectum and the anal canal), and then the PPH anastomosis is inserted into the anus, and the anastomosis removes the prolapsed mucosal band. Since the rectal mucosa above the dentate line is innervated by visceral nerves, patients have almost no pain after the operation; and since the operation not only removes the prolapsed rectal mucosal band, but also blocks the terminal anastomotic branch of the terminal rectal artery, eliminating the root cause of hemorrhoids, it has very ideal treatment effects on internal hemorrhoids, external hemorrhoids, mixed hemorrhoids, circular hemorrhoids, severe hemorrhoid prolapse, prolapse, etc. It has the characteristics of quick effect, quick recovery and no pain after the operation. Scope of application It has a very ideal treatment effect on internal hemorrhoids, mixed hemorrhoids, ring hemorrhoids, severe hemorrhoid prolapse, prolapse, etc. Prolapsed hemorrhoids, i.e. stage II, III, IV internal hemorrhoids or mixed hemorrhoids with mainly internal hemorrhoids, especially those with a ring-shaped circle, are especially suitable for middle-aged and elderly people, white-collar people who focus on efficiency and those who relapse from traditional treatment and those with mild prolapse with internal prolapse of the rectal mucosa. Principle of the procedure A special circular anastomosis is inserted into the rectum through the anus, and the mucosa and submucosa of the lower rectal wall are removed in a circular pattern, and anastomosis is performed at the same time as the removal to lift the prolapsed anal cushion and restore the normal anatomical position of the anal cushion, acting as a “suspension”, while the arterial blood branches supplying the hemorrhoid nucleus are cut off, acting as a “cut-off”. “The technique can be used to treat hemorrhoids by cutting off the arterial blood supply to the hemorrhoid nucleus, thus achieving the goal of radical treatment. Technical advantages 1.Safety：No need to remove the anal cushion, the maximum degree to retain the normal function of the anus, to avoid anal stenosis, anal incontinence and other complications. 2, painless: pulling back the hemorrhoid out of the anus, while cutting off the blood vessels that provide blood to the hemorrhoid, without damaging the perianal skin, so there is almost no pain after the operation. 3.Little trauma and quick recovery: The anastomosis circumferential resection of mucosa is a non-open wound with little bleeding, which eliminates the trouble of changing medicine after surgery and allows you to resume normal life soon. 4.Clinical hemorrhoids, multi-flap hemorrhoids, giant isolated hemorrhoids, internal hemorrhoids, external hemorrhoids, mixed hemorrhoids, circumferential hemorrhoids, embedded hemorrhoids, rectal mucosal prolapse, prolapse, etc. 5.Suitable objects: Because of less damage, it is especially suitable for middle-aged and elderly people, white-collar people who pay attention to efficiency and those who relapse from traditional treatment, and patients with mild prolapse and internal prolapse of rectal mucosa. Contraindications It is not recommended for pregnant women, children, those with persistent constipation, pelvic tumors, portal hypertension, Buicka syndrome or those who cannot tolerate the procedure. Contraindications to PPH surgery include: 1. abscess; 2. gangrene; 3. anal stricture; 4. total rectal prolapse. In the presence of gangrene or infection, anastomotic hemorrhoid fixation is an absolute contraindication to surgery because the procedure cannot remove the source of infection and incision of additional tissue levels can result in pelvic abscesses and fournier’s gangrene (necrotizing fasciitis). Anal stricture is also contraindicated because a dilator (cad) cannot be inserted. Total rectal prolapse is also not a candidate for pph surgery.