Anal and intestinal diseases are common clinical diseases with high prevalence in the population, and “hemorrhoids” in the old saying “nine hemorrhoids in ten people” is a general term for anal and intestinal diseases. Traditional anal and intestinal surgery, post-operative complications, sequelae, but also due to the intense pain after surgery, so that patients fear to accept surgical treatment, and even due to the loss of treatment and lead to increasingly serious conditions. In recent years of clinical practice, the author has introduced the concept of painlessness into anal and intestinal surgery, and through clinical observation and summarization, basically, it can make the patients of anal and intestinal surgery pass through the surgical recovery period in the state of painlessness or minimal pain. Methods The application of local anesthetics generally choose 2% lidocaine 5 ml, bupivacaine 37.5 mg 5 ml, saline diluted to 40 ml, methylene blue 1 ml, epinephrine 0.1 ~ 0.2 ml. For perianal local anesthesia, the amount of drug should not be too large, too large can lead to perianal edema, caused by postoperative distention, and at the same time in the superficial over-application of anesthetics can make the relaxation of perianal skin was The anesthetic can make the loose perianal skin to be “external hemorrhoids” change, or make the original external hemorrhoids become larger, which will lead to the resection range is too large, prolonging the healing period. General anesthetic dosage of 5-8ml, can meet the needs of surgery, such as complex anal fistula or fistula longer or abscess range can be increased to 10-12ml or so. Local anesthesia in the perianal generally choose the truncated position 3, 6, 9, 12 points. Generally truncation position 6 points, that is, after the middle of the caudal bone in front of the infiltration of the amount of drugs to be large, so that the drug was fan-shaped distribution, this area can be closed to the 4th sacral nerve perineal branch, anus caudalis nerve and the pubic nerve branch, the anal relaxation has an important role in the general amount of 2 ~ 4 ml. The two sides of the next, respectively, 1 ~ 3 ml, the amount of drugs used in front of the amount of 0.5 ~ 2 ml. Such as the former part of the absence of lesions, can be not infiltrated. Then it will be appropriately infiltrated in the lesion or surgical site. Discussion From clinical observation, the severity of pain after anal and intestinal surgery is certainly related to the type and severity of the disease, mental state, individual differences, etc., but anesthesia, surgical methods and some specific details of the operation have an important impact on postoperative pain. Through clinical observation, we found that the pain and swelling discomfort after anorectal surgery mainly depends on 2 aspects: the size of trauma and the level of tension in the operation area. Therefore, in order to achieve postoperative painlessness, it is necessary to achieve low trauma and tension reduction, and at the same time, we should be familiar with the anatomy of the anorectal tube and rectum and the different distribution of nerves. Anesthesia For general anorectal surgery, local anesthesia can meet the requirements of surgery. First of all, local anesthesia has less effect on the whole body, and its anesthesia risk is small, and there is no case of anesthesia accident in the observed patients. In addition, the local anesthesia drug properly added epinephrine, not only can prolong the anesthesia time to reduce the toxic reaction of anesthetics, but also can reduce intraoperative bleeding. The application of local anesthesia does not affect the patient’s activities after surgery, while sacral anesthesia and epidural anesthesia patients need to stay in bed for a period of time. Familiar with the anatomical structure and nerve distribution To be familiar with the anatomical structure of the anal verge, anal canal, dentate line and rectum, the anal canal is innervated by spinal nerves, pain response is sharp; and the mucosa above the dentate line is innervated by vegetative nerves, no pain. Therefore, the injection and ligation of internal hemorrhoids should be carried out above the dentate line. And mixed hemorrhoids of the external hemorrhoid part of the peeling should be to the dentate line above and then ligation of the internal hemorrhoid part (generally to peel to the dentate line above 0.5cm or so). And for other anorectal diseases surgery should be avoided as much as possible below the dentate line ligation and suture, unless necessary for hemostasis. At the same time, receptors in the wall of the rectoanal canal ensure fine local discrimination, which contributes to bowel abstinence. Therefore, if the skin of the anal canal is absent as a result of surgery, the defecation reflex may be impaired, resulting in sensory incontinence. Therefore, the skin of the anal canal should be preserved as much as possible during surgery to maintain its physiologic function. Low invasive low invasive that is to minimize the trauma caused by surgery, low invasive can not only reduce pain, but also shorten the healing time. In order to achieve low invasiveness in anal and intestinal surgery, our experience has the following points: (1) For thrombosed external hemorrhoids or varicose external hemorrhoids, small longitudinal incisions should be made from the hemorrhoidal body, and the thrombus or venous plexus should be peeled off through the incision, avoiding the overall resection. (2) For bleeding-based internal hemorrhoids, if there is no prolapse then sclerotherapy injection is the mainstay, the internal hemorrhoid sclerotherapy we perform is to use anti-hemorrhoidal injection, using Shi Zhaoqi 4-step injection method . (3) For internal hemorrhoids that are prolapsed but can be self-retained, with no obvious erosion and no thrombus and wider base, sclerotherapy injection is used. (4) For mixed hemorrhoids with varicose external hemorrhoids, it is not suitable for wide-scale excision of the anal canal skin, the incision can be made under the anal canal skin submerged stripping to remove the veins, as much as possible to retain the anal canal skin. If too much damage to the skin of the anal canal during the operation, it may also affect the function of defecation or lead to the narrowing of the anal canal due to the postoperative scar being too large and inelastic. (5) For anal fistula or anal fissure surgery combined with internal hemorrhoids, try to use sclerotherapy injection. For the fistula longer anal fistula, the use of the anal margin of about 1.5cm outside the fistula incision, the anal margin outside the fistula scratching open drainage. For complex anal fistula, the use of the main incision, branch tube scratching open drainage method, in order to reduce the trauma, reduce damage. (6) for the treatment of anal fissure, the traditional anal fissure excision posterior internal sphincter amputation, surgical incision is large, slow healing, and postoperative anal deformation, we use lateral internal sphincter amputation plus anal fissure hemorrhoidectomy, hypertrophic anal papillae ligation excision, small damage, healing fast, postoperative anal deformation, postoperative virtually painless. Decrease tension Decrease tension even if the tension in the operative area is reduced To reduce tension in anorectal surgery, we experience that the following points should be done: (1) Avoid suturing of the anal canal and the anal verge area below the dentate line. (2) If the postoperative anal canal tension is too high, a longitudinal reduction incision is feasible, and part of the internal sphincter is cut off. (3) When peeling the external hemorrhoids of mixed hemorrhoids, one side should be peeled above the dentate line, and the base of the ligation should be as narrow as possible. (4) For anal papilloma and internal hemorrhoids ligation excision, should be done in its base to reduce the tension incision, and to the dentate line above the appropriate stripping, so that the ligation in the dentate line above. (5) The maximum number of internal hemorrhoids to be ligated is not more than 4. For smaller internal hemorrhoids and parahaemorrhoidal nuclei, sclerotherapy injection can be applied. (6) After completion of surgery, avoid excessive gauze stuffing in the rectal anal canal. Postoperative local edema can also increase local tension and cause pain and swelling. To prevent postoperative edema, the following points should be noted: (1) Remove excess skin from the anal verge to prevent postoperative edema. (2) The incision of the anal verge or anal canal should be “V” shape, even if the base of the retained tissue is larger than the top; meanwhile, the wound should be “∧” shape, even if the wound outside the anal verge is larger than the wound inside the anal canal, so as to make the blood and lymphatic reflux unobstructed and to prevent postoperative edema. Edema. (3) Minimize walking for 24h after surgery to prevent swelling due to poor local blood return caused by standing and walking. (4) Advise patients to consume fiber-rich food or apply laxatives appropriately to maintain soft stools for 24h after surgery to reduce the force of defecation and shorten the time of defecation. Through several years of clinical observation and exploration, the author has worked out the above surgical methods and techniques for painless anal surgery, and has indeed achieved painless or minimal pain after anal surgery.