Anorectal disease is a common and frequent disease, at present the incidence rate in China is 59.1%, of which hemorrhoids account for 87.25%, in the incidence of surgical diseases has occupied a more anterior position, hospitals at all levels of physicians engaged in this discipline every year there is a large increase in the proportion. When the symptoms of anorectal disease are severe and the treatment such as medication is unsatisfactory, as well as the local morphology of anorectal changes are obvious and require restorative changes, it is time to consider surgical treatment, which is the basis for the selection of surgical purposes and indications. For general hospitals, usually, hemorrhoidal fistula fissure surgery in the open shear and ligation techniques predominantly, but large hospitals in a variety of electro-knife resection and special instrumentation operation is also being gradually applied, which, bring a lot of clinical problems, the degree of gain or loss to grasp and respond to the crucial. 1, the construction of the doctor-patient contract patients to the hospital to formulate surgical treatment, doctors and patients invariably formed a contractual relationship, which requires full communication and trust. Doctors and patients have a common pursuit of common interests in the recovery of patients on the one hand, but also the rights and obligations of the other side of the mutual constraints, only in the spirit of mutual trust, the courage to take responsibility for their own behavior, in order to make the two realize the unity of opposites. The preoperative signing of the surgical consent form is used as evidence that the medical institution has fulfilled its obligation to explain and inform, and is also written evidence that the patient and his family have exercised their right to choose informed consent. The patient should understand the pros and cons of the surgical program and make a choice based on several options provided by the medical provider, such as ligation, injection, PPH and other methods when hemorrhoids bleed and prolapse, and high anal fistula with and without hanging threads, etc., and how the expected postoperative effect should be clarified in order to make their own judgments and decisions. Patients should not consider themselves to be on an unequal footing with their doctors, completely at the mercy of their doctors, with no right to make decisions about their right to life and health. Surgical consent is not the doctor to shirk their responsibility of the imperial sword, shield, the terms of the surgical consent, can be understood as a form of terms, it can be argued that, in the event of medical disputes, if the surgical consent form has exemption clauses in the court of law is untenable, the hospital whether to bear the responsibility for medical malpractice or medical negligence, and whether to sign the consent form of the surgical operation does not have any relationship. Therefore, the surgeon should understand Article 33 of the Regulations on the Administration of Medical Institutions, Article 26 of the Practicing Physicians Law, and Article 41 of the Contract Law and other relevant provisions [1], which will help doctor-patient communication and reduce medical disputes. 2, the connotation of surgical gain and loss, gain and loss that is, gain and loss, different contexts have different understandings, containing success and failure, right and wrong, advantages and disadvantages, gain and loss, as well as right and wrong interpretation, but also can be biased to refer to the loss, fault. Gain and loss is a dialectical relationship, to grasp the balance of gain and loss. Gain and loss is reflected in the whole process before and after surgery, doctors and patients should understand what should be gained during surgery, what can not be lost, that is, the upper line and the bottom line. The patient’s gains and losses are reflected in the elimination of disease, health recovery, quantitative performance is all or part; and the doctor’s gains and losses in the response to the knowledge and technology, social value and economic benefits. Among them, the surgeon is most concerned about the success and failure of the operation, the success on the operating table is a decisive success, but not the final result, the failure on the operating table is a complete failure. Secondly, the maturity of the surgeon should not only be shown on the operating table, but also in the preoperative diagnosis, correct decision-making, choice of surgical methods and postoperative treatment, which still plays an important role in the final result of the surgery. 3, “get” the basis for maximization 3.1 “get” position regardless of which side from the doctor and patient, surgery should seek the best results. To this end, the need for communication between doctors and patients to cooperate, before the operation and the patient to set down the operation of the “get” is what degree, so that the patient’s expectations have a reasonable positioning, so that the operation work to go on. 3.2 Preoperative preparation Whether it is an emergency, elective and limited duration surgery, preoperative patients should be fully prepared, including psychological, spiritual, intestinal preparation, etc., have an effect on the anesthesia of the surgery of internal diseases should be actively treated, the body adjusted to withstand the operation state. The anorectal surgeon must also be well prepared, such as understanding the patient’s symptoms, signs, do a detailed local examination, auxiliary examination, the organization of the department and the relevant departments of the necessary consultation, the surgeon also needs to review the information, to understand the cutting-edge dynamics of the diagnosis and treatment of the disease. Verification before the start of surgery is necessary to avoid the risk of the necessary measures, by the presence of anal surgeon, anesthesiologist, surgical nurses in the presence of the three parties to sign a written checkmark to confirm. 3.3 Surgical operation Reasonable surgical design, choice and number of local incisions in the anus, and fine operation and style of surgery are inextricably linked to the surgeon’s talent, experience, number of operating tables, and working hours. Appropriate communication with patients and their families during the operation as appropriate, the preoperative prediction changes during the operation, such as the preoperative think it is very simple, in fact, it is very complicated, should be adjusted in a timely manner, i.e., the “get” change, then we have to strive to maximize, if not communicated, the results of the resulting divergence of understanding. Avoid excessive treatment for patients during surgery, such as treatment of anal fistula, preoperative hemorrhoids due to the absence of hemorrhoids obvious symptoms, and did not talk about hemorrhoids, then do not at the same time to cut the hemorrhoids. Avoid discussing the good or bad of the surgical operation during the operation, and avoid blaming the assistant for the defects. If the patient hears it, it sows a lot of pitfalls and mistrust for the future. 3.4 Surgical time Everything in the world is governed by space and time, and anal surgery is no exception. Operating room and operating table is the stage for surgeons to show their skills, from the beginning to the end of the operation process is first recorded in the form of “operating time”. American doctor Robetr E. Booth, Jr. pointed out that surgeons can be divided into three categories: fast surgery, good results; fast surgery, poor results; slow surgery, poor results. He argues that there is no such thing as a surgeon who operates slowly but effectively. Obviously the ability to perform surgery quickly and efficiently is a prerequisite for becoming an excellent anorectal surgeon. Surgical operation time is long, short, fast, slow, surgical results can be perfect, different doctors in different conditions to do surgery; the same kind of disease different surgical treatment modalities are different, surgical time can not be completely traumatized with the operation and the treatment results are equal. But some routine hemorrhoidal fistula surgery, according to the standard way of operation of most doctors will not be more than 1 hour, some doctors 10-30 minutes can be completed, and another doctor to do more than 1 hour, it is easy to make people doubt the doctor’s skills, or produce the idea of surgery out of the question. Clumsy movements, poorly revealed surgical areas in the anus, and slow opening surgeons are unthinkable. 4, gain or loss of time delayed anal surgery gain or loss of “delayed” refers to the surgical effect is postponed to a certain time later to fully realize that there is a certain timeliness. The success or failure of anal surgery, after the end of the operation, can only give a preliminary judgment, the conclusion of this time with a large, obvious subjectivity and empirical, should not be the final conclusion. Many factors in the postoperative period can make the prediction of success null and void. Unlike surgery in other disciplines, there are many factors that influence postoperative open wound healing. Such as complex anal fistula surgery you think the operation was successful, but, after surgery to a certain time, the external mouth is not closed, there is a cavity or pipe, intra-anal ulceration, this time to change the doctor to diagnose what? Undoubtedly is anal fistula. Therefore, postoperative treatment is to ensure that the “gain” to avoid “loss” of important measures, should be actively and seriously change the medicine, and constantly correct the deviation of the healing process. As anorectal surgeon, the indications for treatment should be precisely understood and selected. The final effect of surgical treatment to what extent there should be a clear understanding, should not be blind and excessive treatment, some surgery is only to improve and alleviate the symptoms, some surgery is only a pre-treatment, but also need a secondary process, some surgical treatment is closely related to the function of the damage, these cases should be fully grasp the “degree” of control is very important. All these cases should be fully grasped, and the control of “degree” is very important. In recent years, the concept of minimally invasive treatment has gradually entered the hearts of the people. Compared with traditional surgery, minimally invasive has the characteristics of small incision, small trauma, fast recovery, less pain and so on. Minimally invasive treatment of anorectal surgery, in addition to the previous characteristics, should be the principle of individualization, the whole pain control, protection of anal function, surgical anal canal skin and mucous membrane loss minimization, repair or restoration of the anus and the lower end of the rectum tissue structure, regulate the physiological function of the anus and rectum, to achieve the purpose of rapid recovery. How to understand minimally invasive anorectal surgery, the academic community has a different understanding, but should not go under the guise of minimally invasive to deceive patients. Traditional injections, ligation (ligature, cookie gun ), lumoscopic polyp electrocision, PPH, high-frequency electrical instrumentation (hcpt) and so on can be associated with minimally invasive. Minimally invasive anorectal surgical treatment is a good aspect of the degree of loss to grasp. 6, “lost” reflection The trajectory of the development of surgery is from simple to complex, and then from complex to simple, although simple, but also complex anorectal surgery. Due to a number of factors, there are many unsatisfactory places, after surgery, doctors and patients regret, remorse often occurs. As a patient, sometimes you can choose, sometimes you cannot choose the outcome. From the surgeon’s point of view, each surgeon needs to improve his or her own level of performance to complete his or her specialty as efficiently and perfectly as possible. Improvement of the realm and skills is the surgeon’s life should pursue the goal, and keen awareness of risk avoidance of anorectal surgeons is also an important and indispensable requirement, so as to minimize the “loss. 7, gain and loss of the statement of medical gain and loss – valued, obsessive. Life gains and losses – look down, put down, at ease. Life gains and losses, let nature take its course. Life gains and losses are always zero, contented people are always happy. The gains and losses of a lifetime are always zero, and the harvest is only the mood. Laugh at the gains and losses, light view of honor and disgrace, free life. Happy life, easy to see the gains and losses. The first thing you need to do is to have a good time and be happy with your life. Do not have to care too much about the momentary gains and losses.