Hemorrhoid is a mass formed by pathological hypertrophy of the anal cushion, downward migration and stagnation of blood flow in the perianal subcutaneous vascular plexus, which can be accompanied by bleeding and prolapse. With the continuous updating of the pathogenesis of hemorrhoids, the concept of surgical treatment has changed from the removal of the hemorrhoid proper to the main purpose of relieving symptoms such as prolapse and bleeding, and the surgical treatment has evolved from the classic procedure based on the varicocele theory of external stripping and internal ligation (i.e. Milligan-Morgan method) to the current anastomotic supra-anal mucosal circumferential hemorrhoidectomy anastomosis designed according to the most popular theory of inferior migration of the anal cushion (i.e. PPH ). The surgical approach has evolved from overall excision to minimally invasive, from simply eliminating the lesion to restoring physiological function and protecting normal tissue. The current surgical treatment of hemorrhoids widely used in clinical practice is now analyzed in a superficial manner: 1. The procedure was modified by Milligan and Morgan at St. Mark’s Hospital in 1937 and is now generally known as the Milligan-Morgan procedure. The main point of this procedure is to make a V-shaped incision with the tip pointing outward at the junction of the skin and mucosa at the lower end of the hemorrhoid, peel upward along the surface of the internal sphincter to the tip of the internal hemorrhoid, suture and ligate the root of the hemorrhoid, and remove the hemorrhoid at 0.3 cm from the ligature line. The advantage of this method is that it is a simple operation and is effective in the eradication of single or relatively isolated internal hemorrhoids from each other. The disadvantages are long operation time, heavy and long postoperative pain, edema, bleeding, long hospitalization time, anal venting time and return to work time, and many complications such as anal stenosis and anal incontinence. 2.Segmental dentate ligation It is a modified external peel and tie procedure, which is a surgical method created by Professor Ding Zemin to treat advanced internal hemorrhoids and annular mixed hemorrhoids. In this method, when separating and ligating the hemorrhoid nuclei, the adjacent nuclei are consciously staggered up and down so that the lines of separation and ligature vertices are distributed in the shape of teeth, thus making the traumatic scars not on the same plane after contracture and preventing postoperative circumferential stenosis of the anus. However, in order to preserve enough “skin bridges” and “mucosal bridges”, the hemorrhoids under the “skin bridges” and “mucosal bridges” are difficult to be treated thoroughly. However, in order to preserve enough “skin bridge” and “mucosal bridge”, the nucleus under the “skin bridge” and “mucosal bridge” is difficult to be treated thoroughly; in order to pursue complete treatment, the epithelium of the anal canal is preserved less and the anal cushion is removed more, which makes the anal canal easy to be narrowed after surgery and leads to defecation difficulties and damages the physiological structure and function. There are also disadvantages of postoperative pain, edema, heavy degree of bleeding, long time, hospitalization time, anal exhaustion time and long time to return to work. 3. The closed procedure refers to resection suturing including semi-open suturing and complete suturing. The semi-open suture is the Parks hemorrhoidectomy, which involves cutting the mucosa of the anal canal and rectum, removing the hemorrhoid tissue underneath, and then re-sealing the mucosa. The aim of this procedure is to remove the hemorrhoidal tissue without damaging the squamous and columnar epithelium that covers the surface of the hemorrhoid; the complete suture, Ferguson’s hemorrhoidectomy, involves clamping the hemorrhoid with a vascular clamp, bluntly or sharply freeing the entire vascular tip of the hemorrhoid and suturing the tip, removing the hemorrhoid, and then suturing the wound. The advantage of the closed procedure is that the sutured wound heals faster and can be less painful if infection does not develop. However, because the sutured wound is easily infected after the operation, the patient needs to control the diet and bowel movement for several days after the operation. This procedure was proposed by Japanese scholar Masahiro Takano in 1989 based on the theory of downward migration of anal cushion. This procedure uses a dumbbell-shaped incision to preserve as much of the anal canal epithelium as possible, which can maintain the integrity and continuity of the anal canal epithelium after healing and plays an important role in maintaining the normal function of the anus. To preserve the anal cushion, care is taken to avoid removing too much subcutaneous and submucosal tissue and to avoid downward migration of the anal cushion. However, there are still disadvantages such as open wound, obvious pain and anal sensory incontinence after removal of sensory epithelium in the tooth line and tooth line area. 5.Anastomotic suprahemorrhoidal mucosal loop anastomosis First reported by Longo in Italy in 1998 [6], it is based on the theory of anal cushion and anal cushion submigration.The aim of PPH surgery is not to remove the prolapsed anal cushion, but to restore its normal anatomical structure.PPH surgery is performed by circumferential excision of the rectal mucosa 2-3 cm wide at 2-3 cm above the dentate line, while anastomosing the two broken ends to lift the The downwardly displaced anal pad is lifted and fixed to return to its normal anatomical position. The advantages are: (1) less or no postoperative pain; (2) shorter operative time; (3) faster postoperative recovery; (4) shorter hospital stay; (5) fewer postoperative complications, no anal stricture and no anal incontinence; (6) flat anal appearance. The recent efficacy of this surgery is relatively certain, but most patients have more frequent and urgent bowel movements after surgery, and occasionally serious complications such as rectovaginal fistula occur, which need to be studied and improved, and the long-term efficacy also needs to be observed and proved, and the price of PPH anastomosis is higher. 6.Summary From the evolution of the above surgical methods, it can be concluded that the current surgery for hemorrhoids has changed from complete removal of the anal cushion to partial preservation of the anal cushion and finally to complete preservation of the anal cushion, which is the result of the continuous updating of the concept of hemorrhoid treatment. However, the long-term efficacy of PPH needs further observation. However, the long-term efficacy of PPH needs further observation. The traditional external peel and internal ligation and its modification, resection and suture, and hemorrhoid surgery with preservation of the anal canal epithelium and anal cushion all have certain advantages and disadvantages. Therefore, it should be the goal of each of our anorectal surgeons to adopt individualized surgical treatment plan for patients with different conditions to ensure the efficacy and minimize the complications.