PPH stands for Procedure for prolapse and hemorrhoids, which directly translates to treatment of prolapse and hemorrhoids. In 1997, Pescatori reported the use of transanal anastomosis with rectal mucosal resection for the treatment of prolapsed rectal mucosa, and in 1998, Longo, an Italian scholar, used this technique for the treatment of prolapsed hemorrhoids and described the mechanism of rectal mucosal loop resection for the treatment of prolapsed hemorrhoids. Yao Liqing in China performed this procedure in 2000 for the treatment of severe hemorrhoids. The principle of PPH treatment for hemorrhoids is to use a circumferential anastomosis to circumferentially remove a section of mucosa 4cm high up from the upper edge of the hemorrhoid while stapling the cut edge together so that the hemorrhoidal tissue can be lifted upward for the purpose of treating hemorrhoids, so this is a method of treating hemorrhoids without cutting them. The theory behind PPH treatment for hemorrhoids is the theory that hemorrhoids are a downward shift of the anal lining. It is believed that hemorrhoids are a normal anatomical structure that is common to all, the anal cushion, which is located at the lower end of the rectum and consists of the blood vessels, smooth muscle and elastic fibers of the submucosa. When the supporting tissues of the anal cushion, Parks ligament and Treits muscle, degenerate and rupture, the anal cushion moves down and forms a prolapsed hemorrhoid. Longo believes that PPH circumferential resection of 2-3 cm of mucosa and submucosal tissues of the lower rectum restores the normal anatomical structure of the lower rectum, i.e., the anal cushion is returned. Also, the removal of submucosal tissues, blocking the blood supply to the hemorrhoidal area from the superior hemorrhoidal artery, and the postoperative atrophy of the hemorrhoidal body are considered to be the mechanism of PPH for hemorrhoids. Because PPH removes only the mucosa and submucosal tissue of the lower rectum, no incision is left in the anal canal and perianal area where sensory nerves are abundant, theoretically reducing postoperative pain. Because the anastomosis is located above the anorectal ring, the chance of sphincter injury is relatively reduced. However, the nature of hemorrhoids is not simply a “liner down”. Within the hemorrhoidal tissue, there is also a large amount of varicose vein mass and hyperplastic redundant skin, both of which PPH can do nothing about. Blocking the blood supply to the hemorrhoidal area from the superior hemorrhoidal artery and the post-operative shrinkage of the hemorrhoidal body is just a guess, but in fact the blood flow at the end of the hemorrhoid is non-abundant and after blocking the superior hemorrhoidal artery, the collateral circulation is rapidly established and the arteriovenous anastomosing branches in the hemorrhoidal tissue need a lot of blood. So, these days, even the Italian doctor longo exclaims that hemorrhoids recur too quickly after PPH! Therefore, longo has developed a modified PPH in cooperation with the manufacturer, which enlarges the mucosal compartment, allows for longer mucosal removal, and lifts the “liner” more significantly. In fact, the key reason for recurrence after PPH is the failure to address the other two pathological factors of hemorrhoids, which are varicose veins and superfluous skin growth. If these two problems are not solved, what is the point of lifting more? Moreover, too much and too tight lifting may lead to rupture and hemorrhage due to too much tension in the anastomosis. I have seen several cases where a hospital doctor performed PPH surgery on a patient without prolapse resulting in hemorrhage. The actual hemorrhoids are not only a good idea, but they are also a great way to get the most out of your hemorrhoids, so that you can use PPH to solve the prolapsed liner problem and surgery to solve the venous mass and superfluous hemorrhoids.