Supra-hemorrhoidal circumferential mucosal resection and stapling (PPH) is a technique for treating severe prolapsed hemorrhoids. It has the advantages of less pain and shorter hospital stay than traditional methods, but it also has certain complications, such as anal swelling and anastomotic stenosis. This is due in large part to the circumferential removal of too much mucosa. The selective suprahemorrhoidal mucosal resection anastomosis (TST) is based on the distribution of the hemorrhoid nucleus, and selectively removes the anastomosed suprahemorrhoidal mucosa to minimize trauma and reduce complications. TST has the same advantages as traditional PPH surgery: (1) cure or significant change in preoperative symptoms; (2) short average operation time of 8-12 min; (3) short return to normal work; (4) few postoperative complications, usually few serious complications; (5) no recurrence of hemorrhoids in a short period of time. TST has advantages that traditional PPH does not have: (1) Using a special anoscope with an open-loop window, only the suprahemorrhoidal mucosa of the diseased hemorrhoidal area is exposed, thus allowing selective removal of the suprahemorrhoidal mucosa; (2) The mucosal bridge between hemorrhoids and the normal mucosa of the asymptomatic hemorrhoidal area are preserved, greatly reducing the number of titanium staples, avoiding the creation of annular scarring, and effectively preventing anal stenosis; (3) The procedure preserves the anal cushion and the ATZ epithelium. (3) This procedure preserves the anal cushion and ATZ epithelial tissue, so that there is no surgical trauma in this area, and less mucosa is removed from the hemorrhoid, so that the anal canal has good defecation reflex and fine stool control after surgery. To a certain extent, it also reduces the postoperative discomfort of swelling and urgency. The TST design is based on the modern concept of hemorrhoids and the concept of minimally invasive treatment. The mechanism includes: (1) selective resection of the mucosa and submucosa in the last 3 cm of the rectum above the hemorrhoid, and completion of its anastomosis in a single operation, which can lift the hemorrhoid tissue and return it to its original position; (2) complete removal of the blood supply from the inferior rectal artery, which significantly reduces the congestion and hypertrophy of the hemorrhoid (2) The blood supply from the inferior rectal artery is completely removed, which significantly reduces the congestion and hypertrophy of hemorrhoids and allows them to return to their original size. Since the anal cushion tissue is preserved to the maximum extent, the anatomy and tissue structure of the anal canal area is kept intact, and there is no incision in the perianal area with rich sensory nerve endings, theoretically TST can not only solve the postoperative pain problem of hemorrhoids better, but also is a minimally invasive technique that can minimize complications such as anal swelling, residual bowel sensation and anastomotic stenosis caused by traditional PPH surgery. TST TST operation method (1) Pre-operative bowel preparation, choose lumbar anesthesia or sacral anesthesia, take prone folding position, perineal disinfection and laying of towels routinely. (2)According to the number and size of hemorrhoids, choose the suitable anoscope for single hemorrhoid with single opening anoscope; 2 hemorrhoids with two opening anoscopes; 3 hemorrhoids with three opening anoscopes. (3) After moderate dilation, insert the anoscope and remove the inner tube, rotate the anoscope so that the mucosa on the hemorrhoid to be removed is located in the open window. (4) For a single hemorrhoid, submucosal suture lead traction is performed 3-4 cm above the hemorrhoid, for two hemorrhoids, two mucosal suture lead traction can be performed separately or both can be performed with a single suture, for three hemorrhoids, segmental packet suture can be performed, if the hemorrhoid is large and prolapsed, double packet lead traction is feasible. The sutures are performed only in the mucosa and submucosa to avoid injury to the muscular layer. (5) Unscrew the tailpiece of the anastomosis clutch counterclockwise, and when the head of the anastomosis clutch is completely untied from the body, insert the head of the anastomosis clutch into the anus expander, tighten the suture around the central rod and knot the suture through the suture export rod to export the suture from the lateral hole of the anastomosis clutch body, and keep traction, tighten the anastomosis clutch clockwise, and pull the prolapsed rectal mucosa through the window of the anoscope into the nail groove of the anastomosis clutch, at this time, feel the resistance of the knob The pointer in the anastomotic window indicates that it is in the firing range. Married women are checked for suturing of the posterior vaginal wall. The body safety is turned on, and the firing is performed, completing the cut and anastomosis. After fixing the anastomosis body and waiting for 30 s, loosen the tailpiece counterclockwise for 3~turns and pull out the anastomosis. (6) Observe the anastomosis, if there is a suture bridge between the two anastomoses, it can be cut directly; the two ends of the projection are clamped and then double ligated with “7” silk thread. If there is active bleeding, “8” sutures are used to stop the bleeding. The specimens were examined and sent for pathological examination. The concept of “preserving as much normal tissue as possible” is an important one in surgery, and it also applies to the treatment of hemorrhoids. TST is certainly a good option for hemorrhoid treatment.