In the anorectal clinic, about 1/4 or more of all types of anorectal disorders are diagnosed as hemorrhoids, and patients often ask what the best treatment is. Will it leave sequelae? Is it possible to do without treatment? Can’t we have a “minimally invasive” procedure? There are two points of view: First, hemorrhoids are the bulging venous masses formed by the tortuous and dilated terminal veins of the lower rectum or anal canal. This view was once widely accepted and is a more traditional understanding. Second, it is believed that in normal people, there is a special tissue structure called “anal cushion” under the mucous membrane at the end of the anal canal and rectum, which is formed in the fetus and its function is to assist in the normal closure of the anus and to control defecation, just like the role of a faucet washer. This view has been shared by more scholars in recent years. After hemorrhoids are formed, not everyone will have symptoms, and those that do are called hemorrhoids. The common term hemorrhoids actually refers to hemorrhoid disease. Hemorrhoids can be classified as internal, external and mixed hemorrhoids depending on where they occur. There are many treatment options for hemorrhoids. The main complications of hemorrhoid treatment are bleeding, infection, anal canal stenosis, etc. In fact, in addition to medication, many patients are more or less worried about all these invasive treatments —– These methods include injection therapy (sclerotherapy injection), withered hemorrhoid therapy, collar ligation therapy, laser microwave therapy, surgical treatments involving various instruments such as HCPT hemorrhoid ablation, PPH therapy, Doppler under hemorrhoid artery ligation, etc. For experienced specialists, all these methods do not present any problems as a complement to the anorectal treatment system. From the earlier laser treatment, microwave treatment, injection treatment to the current HCPT ablation, PPH, RPH, TST treatment, all of them are labeled as “minimally invasive treatment”, although this may be a process of constant elimination and improvement. In fact, “minimally invasive” is only a concept, and it is not a definite surgical method. For doctors who have been in the specialty for a long time, choosing the right tools and operating carefully can achieve the patient’s desired treatment goals and avoid various complications. However, there are many traditional treatments for hemorrhoids, and surgical treatments alone (mainly ligation for hemorrhoids) have resulted in more than a dozen different procedures, so to say that a certain method is “painless” and “completely solves all your worries” is certainly not scientific. Therefore, it would not be scientific to say that a certain method is “painless” and “completely solves all worries”. Strictly speaking, the current types of anorectal surgery (except laparoscopic colorectal surgery) can not be called “minimally invasive surgery”, if you want to catch up with the number, pph surgery is a one-time mucosal cut and anastomosis of hemorrhoids, using special instruments of hemorrhoid circumferential mucosal resection, it is through the hemorrhoid mucosal circumferential excision 4-5cm and anastomosis, will be The method originated in Italy and later spread to China, and now there are also domestic anastomoses. In recent years, retrospective statistics show that the incidence of recent reoperation of pph is not lower than that of traditional surgery. Other things such as full computerized therapy, high-frequency electric knife, etc., the essence is also with the help of instruments without leaving the traditional surgery. It should be said that common anorectal disease is not a major disease, appropriate treatment can achieve satisfactory results, but a variety of treatment methods may be overwhelming, so how to choose? Simply, the most appropriate method for the individual is the best choice. Generally speaking, those with asymptomatic hemorrhoids do not need treatment, and most general treatments for those with 1 – 2 degrees of hemorrhoids are effective. General treatment includes avoiding irritating foods, drinking more water, eating more dietary fiber, keeping the bowels open, and using topical suppositories and ointments that protect the mucosa. Microwave therapy, radiofrequency therapy, collar ligation, and HCPT (high frequency capacitive field) therapy can also be applied to 1 – 2 degree internal hemorrhoids as appropriate, and care should be taken to prevent complications. For 3rd – 4th degree internal hemorrhoids, mixed hemorrhoids and thrombosed external hemorrhoids, most of them require surgery. Ligation therapy and the various procedures derived from it are still the most valuable methods of hemorrhoid treatment at home and abroad. Although many institutions in China use “surgery” as a counterpoint to promote certain “new methods”, the essence of minimally invasive surgery is – incision paths guided by traditional surgical principles and minimizing tissue damage. Whether accepted or not, traditional surgery is still the most valuable and safe treatment for hemorrhoids, and is the most common treatment in the anorectal departments of specialized hospitals in China. The basic principle of minimally invasive surgery is the keyhole technique, which means that the surgical incision to expose the deep lesion is just right, just like a key to open a lock, and never causes excessive damage. Minimally invasive surgery encompasses all traditional medical fields, it is not only surgery, but also involves internal medicine, radiology, ENT and other fields. It mainly includes thoracoscopic techniques, laparoscopic techniques, urethroscopic techniques, arthroscopic techniques, laryngoscopic techniques, etc. In conclusion, the aim of hemorrhoid treatment is to relieve the symptoms, not to eradicate the hemorrhoid itself. Therefore, it is important to analyze the problem on a case-by-case basis and not to “treat hemorrhoids on sight”. Unnecessary or incorrect treatment of the patient may cause unnecessary harm to the patient, and some may even have sequelae. For PPH surgery, the rationale is based on an understanding of the pathogenesis of hemorrhoids —- that the anal cushion has shifted down. For selective cases of stage 3 annular prolapsed internal hemorrhoids can achieve results, in the case of hemorrhoids also have their limited indications, PPH as one of the surgical treatment modalities for hemorrhoids is still far from overturning the traditional hemorrhoid surgery.