Hemorrhoids are a common anal disease, and there is a saying that “nine out of ten people have hemorrhoids” in intestinal medicine. As people’s standard of living continues to improve and the quality of life continues to improve, the incidence of hemorrhoids is getting higher and higher, and it is plaguing people’s lives. The treatment of hemorrhoids is divided into surgical treatment and non-surgical treatment, non-surgical treatment is for relatively light hemorrhoids, drug treatment can achieve the effect of clinically asymptomatic; surgical treatment is for non-surgical treatment and can not achieve the treatment method of relieving the pain, and the effect is obvious. The concept of PPH: PPH is an anastomotic hemorrhoid fixation, also known as anastomotic hemorrhoid circumferential hemorrhoidectomy, which is based on the theory of anal cushion and is a new technique of using anastomosis to treat annular prolapsed hemorrhoids, as proposed by Longo in 1998. PPH, or anastomotic hemorrhoidectomy, is suitable for all types of ring prolapsed hemorrhoids, especially for patients with severe internal hemorrhoids and partial rectal mucosal prolapse. The principle is that the anal cushion is preserved and an instantaneous anastomosis is performed along with the circumferential excision and anastomosis of part of the internal hemorrhoid and the mucosa and submucosa tissue on the hemorrhoid. It not only blocks the blood supply of the hemorrhoid, but also fixes the slipped tissue in suspension, and restores the pathological anorectum to its normal anatomical state. The scope of application: It has a very ideal treatment effect on mixed hemorrhoids, annular hemorrhoids, severe hemorrhoid prolapse, prolapse, etc. It is used for the treatment of Ⅲ and Ⅳ degree internal hemorrhoids. Surgery principle: Using a specially designed circular anastomosis inserted into the rectum through the anus, the mucosa and submucosa of the lower rectal wall are removed circumferentially, and anastomosis is performed at the same time to lift the prolapsed anal cushion and restore the normal anatomical position of the anal cushion, which plays the role of “suspension”, while the arterial blood branches supplying the hemorrhoids are cut off, which plays the role of “disconnection”. The procedure can be performed to restore the normal anatomical position of the anal cushion and to play the role of “suspension”. The first step is to insert the PPH anastomosis into the painless area about 4 cm above the junction line between the rectum and the anal canal for treatment. In the second step, the PPH anastomosis is completed instantly by circumferential excision of about 3 to 100 px in part of the internal hemorrhoid and the mucous membrane and submucous layer of tissue on the hemorrhoid, while the anastomosis is completed instantly, blocking the bleeding of the hemorrhoid supply vessels and at the same time suspending the slipped tissue upward to fix it. In the third step, the vascular supply of hemorrhoids is cut off, and the internal and external hemorrhoids automatically shrink, thus eliminating the root cause of hemorrhoids and avoiding their recurrence, and achieving the purpose of treatment. V. Technical advantages: 1. Safety: No need to remove the anal cushion, which maximally preserves the normal function of the anus and avoids complications such as anal stenosis and anal incontinence. 2, painless: pull the hemorrhoid out of the anus back to its original position, while truncating 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 hemorrhoids, multi-flap hemorrhoids, giant isolated hemorrhoids, mixed hemorrhoids, ring hemorrhoids, embedded hemorrhoids, rectal mucosal prolapse, prolapse, etc. 5.Suitable object: 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 with traditional treatment, and patients with mild prolapse and rectal mucosal prolapse. Contraindications: PPH is not recommended for pregnant women, children, patients with persistent constipation, pelvic tumors, portal hypertension, Bucca syndrome or those who cannot tolerate surgery. The treatment mechanism of PPH is to circumferentially excise a section of mucosa above the hemorrhoid nucleus, and at the same time anastomose the rectal mucosa at the distal and proximal ends, so that the prolapsed anal cushion tissue can be lifted, and in addition, because the mucosa is excised and anastomosed, the blood supply is also partially blocked, so that the blood vessels in the excessively proliferated and expanded anal cushion area can be partially atrophied due to the reduction of blood supply, thus achieving the purpose of stopping its prolapse. The best indications for this procedure are stage III internal hemorrhoids, circumferential mixed hemorrhoids, and low rectal mucosal prolapse. As a new treatment method, it is theoretically in line with modern hemorrhoid treatment principles, since the tissue of the anal cushion area is not damaged and its reflex to defecation is not affected, and the closing and pressure-boosting effect of the anal cushion on the anus is not affected. From the results of the operation, the recent results are good. The problem is that the method has not been introduced into China for a long time, so the long-term efficacy remains to be observed, and there are some complications, such as postoperative hemorrhage, anastomotic infection, etc. In addition, some complications are quite serious, including intestinal fistula, rectovaginal fistula, pelvic infection leading to sepsis, and there are reports of death. Some foreign experts have described that some cases have recurrence after 16 months. Eight, surgical comparison: non-surgical treatment: diet therapy, oral medication, external medication, injection therapy, withered hemorrhoid therapy, infrared therapy, cryotherapy, laser therapy, etc. Traditional surgical treatment: the use of external peeling and internal ligation to remove the nucleus of hemorrhoids is the most commonly used treatment for severe hemorrhoids in recent years, traditional surgical treatment has postoperative pain and longer hospitalization and healing time. Nine, complications 1, anastomotic bleeding: the incidence is still about 50% after the improvement of instruments. For treatment, 0/2 absorbable sutures are used under anoscope to make hemostatic sutures across the anastomosis. 2, anastomotic dehiscence and concurrent bleeding: divided into intraoperative dehiscence and postoperative dehiscence intraoperative dehiscence is commonly caused by excessive spacing between nail cuts and instrumentation errors. Postoperative dehiscence is commonly caused by insufficient nail cutting, excessive nail cutting spacing, or poor nailing and incomplete cutting. Post-operative anastomotic infection and post-operative constipation are the causes of multiple factors. Anastomotic dehiscence is divided into total and partial dehiscence, but the treatment is the same, i.e., the original surgical concept is followed, the original state of surgery is restored, and the anastomotic reinforcement suture is implemented. Small partial dehiscences without bleeding symptoms do not require surgical treatment and can heal naturally. 3, anastomotic nail delayed detachment: this symptom is related to the intraoperative nail state, depth, location, hemostatic suture can also make the anastomotic nail deeply buried off difficulties. The complication is less common when the anastomosis is located in the mucosal layer of the lower rectum. The general incidence is about 20%. Treatment: two to three weeks after surgery anoscopic clamp out. 4, postoperative external hemorrhoid edema and subcutaneous thrombosis below the anastomosis is often related to the anastomotic part of the dehiscence, the lighter can be treated with topical drugs, if necessary, thrombectomy. External hemorrhoid prolapse is often combined with partial anastomotic dehiscence, and if it does not improve with external medication, ligature excision or surgical excision can be considered to remedy the situation. 5. Postoperative infection around the anastomosis and submucosal hematoma, abscess formation and rectovaginal fistula Most of them are related to surgical operation with irregular anastomotic suture causing miscutting, entrapment and strict disinfection. Misalignment of the peri-anastomotic tissue structure due to incorrectly performed double purse-string sutures is also a factor in the formation of infection. Small hematomas can be treated with natural absorption. In case of abscess formation, the rectal cavity should be opened and drained as early as possible. Submucosal infection at the lower end of the anastomosis can easily form a subcutaneous fistula, and deep infection above the anastomosis can easily form complicated perirectal infection and pelvic floor infection and rectovaginal fistula when incision is delayed, and these complicated complications are very serious for the patients, and perirectal infection and pelvic infection can seriously cause necrotizing fasciitis and infectious shock, and these will be life-threatening if not treated timely and properly. If these are not treated timely and properly, the patient’s life will be in danger; rectovaginal fistula is more than worth the loss for female patients, because it not only affects the patient’s quality of life, but also brings great physical and mental pain to the patient. The incidence of postoperative anastomotic stenosis is 15%, often a simple linear stenosis. The occurrence of the disorder is related to the scar body of the patient. It is also related to excessive anastomotic suture involvement of the muscle layer, anastomotic infection and excessive hemostatic suture treatment. Treatment: anoscopy under a high-frequency electric knife, perform multi-quadrant superficial incision and loosen the stenosis ring. 7, postoperative pain: common postoperative pain in the small abdomen on the first day, as normal. When the anastomosis is too low, touching the epithelial nerve of the anal canal or the anastomotic suture is too deep into the muscle layer of the intestinal wall or involving more hemorrhoid tissue can cause anal canal spasm and pain, which can naturally improve after two or three days with the healing of the wound. Do the necessary pain relief treatment after surgery. 8.A small amount of bleeding in the anal canal for a short period of time after surgery. A small amount of bleeding in the anal canal for a short period of time after surgery is related to anastomotic nail detachment, and long-term intermittent rectal bleeding must be examined by colonoscopy. 9.Anal papilla hypertrophy and hyperplasia around the anastomosis after surgery should be considered as related to anastomotic stimulation. Treatment: Intraoperative detection of diseases related to the anastomosis surrounding the anastomosis, together with surgical treatment is preferable. In case of anal canal spasm, appropriate anal dilation should also be done. 10. Anal swelling pain and discomfort refers to the perianal swelling pain that occurs after surgery and is closely related to surgery, which is also a common clinical symptom. Ten, PPH surgery in the implementation of misconceptions 1, PPH surgery to treat endorectal prolapse and outlet obstruction type constipation, it can be said that the implementation of PPH surgery in addition to solving the prolapse of hemorrhoids, taking into account the treatment of part of the rectal mucosa relaxation. For patients with endorectal prolapse, it is impossible to completely improve the symptoms by removing 2-75px wide loose mucosa with PPH surgery, because exit-obstructive constipation caused by many factors such as loose rectal mucosa, pelvic floor descent, pelvic floor spasm, anterior rectal protrusion and spasm of anal sphincter cannot be cured so easily. 2, the role of PPH surgery in the treatment of rectal protrusion, there are doctors have been clinical investigation of this, we speak of PPH surgery in the treatment of prolapsed hemorrhoids at the same time, the relaxation of late intestinal mucosa or rectal protrusion has a certain support, fixed role. Throughout the classification of rectal prolapse and a variety of surgical methods, especially for moderate and severe rectal prolapse can not be replaced by PPH surgery, so simple and easy to perform. 3, PPH surgery for initial internal hemorrhoids, especially for young female patients should be implemented with extreme caution, as the patient is unmarried and cannot be fingerprinted, coupled with the close rectovaginal compartment in young women, such as the load suture is too deep, it is easy to draw into the posterior vaginal wall causing blind damage. 4, to PPH surgery to remove the wide based polyps in the rectum or to close the internal opening of the internal fistula, often using a semi-ring or focal rectal mucosal resection, only in very special cases, there are already TEM surgery carried out, which is more advantageous and safe for the treatment of diseases in the rectum.