In 2006, the three major professional societies of the anus and intestines formulated the “hemorrhoid clinical diagnosis and treatment guidelines” pointed out that: hemorrhoidal disease treatment principle for asymptomatic hemorrhoids do not need to be treated, symptomatic hemorrhoids that hemorrhoids need to be treated; the purpose of the treatment focuses on the reduction and elimination of the main symptoms, rather than the root cause; relieve the hemorrhoidal symptoms than change the hemorrhoidal size is more meaningful, should be regarded as a standard of the therapeutic effect.1; when the failure of conservative treatment or the third and fourth stage of internal hemorrhoids around the When conservative treatment fails or the connective tissue around the third or fourth stage of internal hemorrhoids is widely destroyed when considering surgery, it is reasonable to first consider a kind of not only can promote the fibrosis of the tissues around the hemorrhoids, the prolapsed mucosa of the anorectal tube will be fixed in the muscular layer of the rectal wall, in order to fix the loosening of the anal cushion, but also achieve the purpose of haemostasis and prolapse prevention of the safe and simple surgical methods, that is, to protect the anal cushion, so that the pathologically enlarged, displaced cushion of the anal cushion to return to normal. External peeling and internal ligation and anastomotic hemorrhoidal mucosal cricothyrotomy are still the mainstay of anorectal surgery for the treatment of mixed hemorrhoids, especially severe hemorrhoids. As a more aging city, Shanghai poses a challenge to doctors in terms of treatment strategies for hemorrhoidal diseases. For the elderly, most of them have varying degrees of comorbid medical diseases in the presence of hemorrhoidal disease, which reduces their ability to tolerate surgery, so surgical resection is a deterrent for most doctors. Hemorrhoidal disease in the elderly has become one of the major diseases affecting the quality of life of the elderly. Due to many factors such as poor local venous return to the anus, vascular sclerosis and hyperplasia, decreased anal sphincter function and decreased hemorrhoidal vein pump function and hemorrhoidal cushion downward displacement in elderly patients,2 the incidence of hemorrhoidal disease in the elderly is significantly higher than that in other age groups, and most of them have a course that extends over several years or undergoes several surgeries. The majority of elderly patients have varying degrees of cardiopulmonary disease, and some also have diabetes, hypertension and other disorders. As a matter of fact, hemorrhoidal disease in the elderly has obvious characteristics, most of them have blood and prolapse as the main clinical manifestations. In view of the characteristics of elderly hemorrhoidal disease patients, the selection of safe, fast, less painful and less irritating therapies that can satisfy the symptoms of the individualized relief as the main standard of treatment, therefore, the surgical plan for hemorrhoidal disease in the elderly should be selected for the symptoms of the use of a single or comprehensive minimally invasive surgical methods such as injection, hemorrhoidal arterial ligation, collagen ligation, and other minimally invasive surgical procedures, such as hemorrhoids. Arterial ligation, rubber band ligation, anastomosis hemorrhoidal mucosal circumcision and so on. 1, minimally invasive basic surgery (1) injection indications: internal hemorrhoids I-II stage. Most of the sclerosing atrophy injection therapy, you can choose “eliminate hemorrhoid injection” or “An injection”, the mechanism for the injection of local tissue to produce aseptic inflammation, so that the subrectal arteries, venous plexus embolism and hemorrhoidal interstitial fibrosis, adhesion and hardening, thus leading to the disappearance of hemorrhoidal atrophy. Limitations of injection therapy: it is not suitable for patients with external hemorrhoids, and older patients with hemorrhoids accompanied by hypertension, cardiac, hepatic and renal diseases are included in the contraindications to surgery. (2) hemorrhoidal artery ligation indications: internal hemorrhoids stage I-II, or mixed hemorrhoids internal hemorrhoids bleeding stage, or accompanied by partial prolapse, can consider the addition of suspension of hemorrhoidal nucleus body ligature suspension. In 1995, Professor Morinaga of Japan first used hemorrhoidal artery ligation for the treatment of hemorrhoidal disease, as a simple, safe, painless, effective and low invasive minimally invasive surgical treatment in Japan, Europe, the United States and other developed countries have achieved success, and more satisfactory results.3 The superior hemorrhoidal artery is the terminal branch of the superior rectal artery, which is distributed in the right anterior, right posterior, and left median rectal column, and it has been found that that by effective ligation of the superior hemorrhoidal artery the blood supply of the superior hemorrhoidal artery, which is located in the submucosal layer, can be blocked, thus reducing the blood flow to the venous plexus of the internal hemorrhoids, thus reducing the size of the hemorrhoidal core and alleviating the symptoms. Bursics et al. concluded that this procedure is an ideal method for treating hemorrhoidal disease and meets the conditions of minimally invasive surgery, with simple, safe, effective, mild pain and fewer complications, and that its hemostatic efficacy is precise, with little trauma and a short postoperative recovery time, which is in line with the trend of the development of minimally invasive surgery.4 Wang Yehuang5 et al. carried out a preliminary clinical observation on the ultrasound Doppler-guided ligation of hemorrhoidal artery for the treatment of internal hemorrhoids, and the results showed that the hemorrhoidal artery ligation has clear efficacy without bleeding, pain, edema, and other common complications of traditional surgery, such as combining with suspension method to treat hemorrhoids, which has obvious advantages compared with traditional surgery. Lin Hui et al6 used hemorrhoidal artery ligation and anal cushion suspension to treat 92 patients with III and IV degrees of internal hemorrhoids and mixed hemorrhoids, and randomly divided 92 patients with prolapsed hemorrhoids of stage III-IV into 46 cases each in the treatment group and control group, which were treated with hemorrhoidal artery ligation and anal cushion suspension and the Milligan-Morgan procedure, respectively. The postoperative pain, edema, blood in stool, anal swelling and other clinical index scores, and wound healing time were observed in both groups. RESULTS: Both groups were cured. The incidence of postoperative pain, dysuria, dyspareunia, bleeding and other symptoms in the treatment group was significantly less than that in the control group (P<0.05). The average healing time was (5.60±2.47) days in the treatment group and (15.40±3.58) days in the control group; the difference was statistically significant when comparing between groups (P<0.05). Conclusion: Hemorrhoidal artery ligation anal cushion suspension is a simple, safe and effective method for treating stage III-IV prolapsed hemorrhoids. (3) Ligation Indications: all stages of internal hemorrhoids or mixed hemorrhoids of the internal hemorrhoid part. Hemorrhoid ligation has a long history, China's ancient hemorrhoids have been hemorrhoids line ligation related records, "fifty-two disease formula": "Peony hemorrhoids living next to the orifice, tied to a small rope, dissected with a knife." Ligation with the aid of instruments was first used by Blaisdell in 1954 to tie internal hemorrhoids with silk or intestinal threads by means of a small instrument. 1963 saw the improvement of the ligature by Baroon with the use of adhesive coils, which has since been widely used. Compared with traditional hemorrhoidectomy, with proper use of collars, collars ligation is associated with less pain, complications and recovery time. Negative pressure suction ligation makes the operation more convenient, so it develops rapidly and soon replaces other ligation methods. Although glue ring ligation therapy is considered a safe method, there are some complications reported in clinical reports, commonly bleeding, pain, swelling, edema, difficulty in urinating and other complications, and even reports of causing serious infections.7-11 Wu Bin et al. used automatic hemorrhoidal ligature to treat 35 cases of ASA grade II~III hemorrhoids in the elderly12 with satisfactory efficacy. In this group, there were 35 cases, 23 males and 12 females; age 50-86 years old, average 65.9 years old. Among them, there were 30 cases of mixed hemorrhoids and 5 cases of simple internal hemorrhoids. All of them were combined with cardio-cerebral respiratory and other systemic diseases. There were 27 cases of blood in stool and 8 cases of anal mass prolapse. The longest duration of the disease was 20 years. All of them were treated with medication, and the effect was not good. Treatment: 1d before the operation into the semi-liquid, the night before the operation and the morning of the operation each clean enema 1 time. Perianal local anesthesia was used, and the instruments used were BN-TZQ-01 automatic hemorrhoidal ligature, including ligature gun and negative pressure suction connector. The patient took the side lying down, connected the negative pressure suction connector to the exogenous negative pressure suction system, and made sure that the negative pressure release switch was off. Sterilization was performed to reveal the dentate line and hemorrhoidal nuclei. Place the lance tube through the anoscope or directly to the target, under the negative pressure suction, the tissue is sucked into the lance tube. When the negative pressure value reaches -0.08-0.1 mpa, you can turn the ratchet, release the rubber ring, the target tissue is firmly set. Open the negative pressure release switch to release the ligated tissue. If there are multiple hemorrhoids, operate in the same way one by one. Up to 3 hemorrhoids are ligated at a time. The procedure is completed within a few minutes. The patient will be put on fluids for 1 day and will not be allowed to defecate on the day of the operation. For those who usually have difficulty in defecation, oral laxative herbal medicine was given for 1 week from the 2nd day after surgery. Results: 34 cases of postoperative spontaneous urination, 1 case of catheterization. the pain evaluation of NRS method was less than 3. the time of detachment of the adhesive ring was 3-18 days. Average 10 days. 1 month later review, blood in the stool all stopped, the feeling of defecation or anal swelling in 8 cases (22.9%), 2-3 days after self-relief. Postoperative hemorrhoidal retraction was incomplete in 2 cases (5.7%). There were no complications such as anal stenosis and anal fistula. Patient satisfaction showed that 30 cases (85.7%) were satisfied, 3 cases (8.6%) were basically satisfied, and 2 cases (5.7%) were dissatisfied. 2 cases of the rubber ring fell off in 3 days, and anoscopy found that the ligated hemorrhoidal nuclei were necrotic and incompletely dislodged, and mucous membrane at the place where the rubber ring was dislodged was vesiculated and thrombosis was formed, accompanied with little bleeding, and the ligature was given again. (4) anastomosis hemorrhoidal mucosal circumcision Indications: III, IV stage internal hemorrhoids or mixed hemorrhoids. In 1998, Longo was the first to use anastomotic supramucosal hemorrhoidal circumcision (PPH) to treat stage III and IV internal hemorrhoids on the basis of the doctrine of anal cushion displacement, but it can only well solve the internal hemorrhoids and flaccid lower rectal mucosa but not external hemorrhoids, resulting in the residue of the skin cumbersomeness after the operation, and the shape of anus is not flat, which reduces the patient's quality of life. Shan Jianfeng et al13 used anastomosis hemorrhoidal supramucosal circumcision to treat 143 cases of hemorrhoids in the elderly in this group of 143 cases, 85 men and 58 women; age 60-82 years old, average 68 years old. There were 83 cases of internal hemorrhoids and 60 cases of mixed hemorrhoids. There were 20 cases of anal fissure, 11 cases of anal papillary fibroma and 21 cases of thrombosed external hemorrhoids. The shortest medical history was 20d, the longest was 38 years, and the average was 2 years. There were 72 cases of hypertension, 49 cases of coronary heart disease (27 cases confirmed by coronary angiography), 9 cases of diabetes mellitus, 3 cases of cerebral infarction sequelae, and 1 case of cirrhosis in compensatory stage. Results: The operation time of this group was 15~35 min, average 20 min, and the operation process was smooth without hemorrhage and anesthesia accident, etc. All the internal hemorrhoids were effectively retracted. The internal hemorrhoid retraction was effective, and the external hemorrhoid retraction efficiency was 63.4%. The average postoperative hospitalization was 6 d. There were 3 cases of delayed anastomotic hemorrhage (2.1%), which occurred 7-14 d after surgery, and all of them needed surgery to stop bleeding. There were 63 cases (44.1%) of postoperative blood in stool or blood dripping during defecation, and the situation improved after giving medicine change and hemorrhoidal suppository. Postoperative anal pain was found in 75 cases (52.4%), with an average pain duration of 7 h (2-48 h), requiring tramadol for pain relief in 11 cases (7.7%). Postoperative urinary retention was found in 53 cases (37.1%), of which 11 cases required indwelling catheter. Postoperative fecal incontinence was observed in 3 cases (2.1%) and recovered after an average of 6 d. No rectovaginal fistula occurred. No serious complications such as rectovaginal fistula and pelvic infection occurred. Limitations of anastomotic suprahemorrhoidal mucosal cricothyrotomy: expensive price, high patient expectations, and potential risks to medical safety; higher incidence of postoperative complications of urinary retention in elderly men; and fecal incontinence in some patients. 2, the diagnosis and treatment strategy of hemorrhoidal disease in the elderly: hemorrhoidal disease in the elderly with repeated bleeding, prolapse or even incarcerated necrosis symptoms should be surgical treatment, and should take into account the patient's general condition, choose the appropriate, less traumatic and even on the systemic impact of the small surgical program. We should pay attention to the comprehensive preoperative examination and adequate preparation, in addition to the routine examination, we should actively discuss with anesthesiologists to choose the appropriate anesthesia, and work with internal medicine doctors to do a good job in the preoperative analysis and postoperative prediction and evaluation of the situation that may occur after the operation, if necessary, choose drugs to control, and consider surgical treatment after the condition is stabilized, and also pay attention to the postoperative care and prevention of infections.