What is PPH? PPH has been successfully performed on 300,000 hemorrhoid patients worldwide, and in China, nearly 15,000 patients have undergone the procedure since its inception in 2000. PPH, or anastomotic hemorrhoidopexy, is suitable for patients with all types of hemorrhoids, especially severe internal hemorrhoids and partial rectal mucosal prolapse. The principle is to preserve the anal cushion and perform instantaneous anastomosis while removing and anastomosing part of the internal hemorrhoid and the supra-hemorrhoidal mucosa and submucosal tissue in a circular fashion. It not only blocks the blood supply of hemorrhoids, but also fixes the slipped tissues in suspension and restores the pathological anorectum to its normal anatomical state. The PPH technique, also known as supra-hemorrhoidal circumferential hemorrhoidectomy, is a new technique based on the 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 procedure is performed by widening the anus and suturing the rectal mucosa in a loop about 4 cm above the dentate line (the junction line between the rectum and the anal canal), then inserting the PPH anastomosis into the anus, the anastomosis can remove the prolapsed mucosal band, and the whole procedure takes only about half an hour. 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 procedure can be performed by cutting off the arterial blood supply to the hemorrhoid nucleus, thus achieving the goal of radical treatment. Procedure Step 1: A special round anal canal dilator is introduced into the inside of the anus to partially reset the prolapsed hemorrhoid or prolapsed anal canal mucosa. Step 2: The inner part of the dilator is removed and an anoscopic suture is introduced to close the prolapsed mucosa, depending on the extent. This step is known as “making the purse” and the condition of the purse can vary depending on the prolapsed hemorrhoid. Step 3: Unscrew the circular hemorrhoid anastomosis so that the staple head penetrates deep into the upper end of the purse string and then knot the sutures. Step 4: Pull the sutures so that the prolapsed mucosal layer is placed in the cavity of the anastomosis, close the anastomosis, and remove the prolapsed mucosa after determining the position due to the sharp knife and suture system of the anastomosis. It is rested for 30 seconds to stop the bleeding with sutures. The dilator and anastomosis are removed. Technical advantages 1.Safety: No need to remove the anal cushion, retaining the normal function of the anus to the maximum extent and avoiding complications such as anal stenosis and anal incontinence. 2.No pain: Pulling the prolapsed hemorrhoid back to its original position, 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 hemorrhoid, multivalve hemorrhoid, huge isolated hemorrhoid, internal hemorrhoid, external hemorrhoid, mixed hemorrhoid, circumferential hemorrhoid, embedded hemorrhoid, 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.