PPH has been carried out in China for 10 years, and now it has become the country with the most PPH treatment in the world. The advantages and disadvantages of PPH have been fully explored in the past ten years of practice. Overview of the development of PPH In 1997, Pescatori first reported the treatment of rectal mucosal prolapse by transanal anastomosis, and in 1998, Longo A, an Italian, completed the first case of PPH for hemorrhoid prolapse in the world. 1999, PPH was introduced to Asia, first carried out by Seow Choen, a Singaporean professor, and then introduced to China in June 2000. PPH has been successfully performed on 300,000 cases of hemorrhoid patients worldwide. More than 30 provinces and cities in China are currently carrying out PPH technology, and nearly 15,000 patients have successfully undergone the technology. Regarding the naming of PPH, the anastomotic hemorrhoid fixation, Longo method, anastomotic anoplasty, anal membrane fixation, anastomotic rectal mucosal resection, transverse mucosal prolapse resection, prolapse fixation, etc. that appear in the journals are all the same method as PPH. PPH surgery principle PPH surgery is performed by removing the 2cm-4cm annular rectal mucosal band on the tooth line and anastomosing the distal and proximal mucosa at the same time, which on the one hand lifts the pathologically flaccid anal cushion, restores the normal anatomical structure of the anal canal mucosa and sphincter, and ensures the normal fine defecation function of the anal canal after surgery. On the other hand, the surgery reduces the blood flow under the anastomosis, and the hemorrhoid nucleus gradually atrophies after the surgery. Therefore, it can be summarized as “cut off the flow”, “suspension”, “fixation” and “reduction of accumulation”. The indications for PPH are: ① Patients with internal hemorrhoids that bleed; ② Patients with prolapsed hemorrhoids that can be fully retracted; ③ Patients with prolapsed rectal mucosa or combined with prolapsed rectal mucosa; ④ Exclusion of other colorectal diseases. Relative indications: ① Patients with cyclic mixed hemorrhoids that can be fully retracted after external peeling and internal ligation of a single nucleus at the patient’s request; ② Patients with cyclic hemorrhoids that are combined with fresh anal fissure, subcutaneous fistula, anal myxoma, thrombosed hemorrhoids, and anterior rectal protrusion. The advantages of PPH surgery compared with traditional surgery include the simultaneous completion of excision and anastomosis, which is simple to operate; the operation is performed on the dental line controlled by the vegetative nerve, and the pain during and after the operation is light: the operation preserves the anal cushion tissue, and the anal function is less affected; the incision heals in one stage, which shortens the hospitalization and recovery time. In summary: ① PPH surgery is more in line with the modern trend of minimally invasive anorectal surgery; ② there is an essential difference in the purpose of surgery, the purpose of PPH surgery is to reset the pathologically altered anal cushion tissue, while the traditional surgery directly destroys the pathologically altered anal cushion tissue; ③ the principles and mechanisms of surgery have some commonality, both are aimed at symptomatic hemorrhoids, i.e., elimination of symptoms; ④ the indications for surgery, both have their strengths. The traditional surgery has a greater impact on the function of the anus because the normal anal canal skin is removed. Complications of PPH Since 2000, the published literature shows that PPH is a relatively safe procedure. However, each of its steps may lead to serious complications. (5) Sensory incontinence and increased frequency of defecation may be caused by surgical removal of the submucosal plexus, reduction of the rectum by stretching the rectum, and postoperative stretching and thinning of the sphincter: (6) Postoperative swelling and pain are related to the absorption of the anastomotic intestinal line and submural hematoma, which can improve on their own; (7) Anal myxoma formation may be caused by long-term inflammatory stimulation of the anastomotic tissue hyperplasia; (8) Premature removal of the titanium nail, and premature removal of the upper anal cushion tissue. The premature detachment of the titanium nail and the unadhered tissue of the supra-anal pad can lead to partial ectropion of the external hemorrhoid below the anastomosis to form a mass prolapse affecting the surgical effect, which may be related to the still high intra-anal pressure, dry stool and diarrhea of the patient after surgery; ⑨ pelvic sepsis and retroperitoneal infection, although not yet reported in China, are prevented by the routine use of general antibiotics after surgery; ⑩ no effect on external hemorrhoids, which are often stimulated to lead to anal papillary hypertrophy after surgery. Outlook PPH is encouraging in terms of its advantages in the treatment of cricoid hemorrhoids, with less patient pain, faster recovery, and no impact on anal function, and is a major change in the field of cricoid hemorrhoid treatment. However, anastomosis is expensive, cannot be reused, and requires skilled surgical skills and learning process. 2004, our department took the lead in carrying out anastomosis for hemorrhoids and rectal prolapse in Guangxi region, which obviously reduced the economic burden of patients and has successfully cured more than 1000 cases. for patients with circumferential hemorrhoids, mainly internal hemorrhoids prolapse, PPH is less painful, less bleeding after surgery, and avoids damage to anal function. At the same time, our department has accumulated a lot of experience in treating circumferential mixed hemorrhoids with combined anterior rectal protrusion, rectal mucosal prolapse, anal myxoma, anal fissure and subcutaneous fistula using PPH, and its clinical efficacy is satisfactory, but of course there are also a lot of complications, which is also taken as a summary. At present, the emergence of TST alleviates some of the complications of PPH.