الفهرس 
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Abstract
Hemorrhoids are one of the commonest human ailments, piles are classified as internal and external piles, the former arising in the upper two-thirds of the anal canal, the latter in the skin-covered lower One -third of the anal canal (Loder et al., 1994). The principal cause of hemorrhoid disease seems to be congestion and hypetrophy of the internal anal cushions or prolapse of the vascular cushion other causes for hemorrhoids are heredity, constipation, diarrhea and straining at stool, prolonged standing or straining at work or recreation, relaxation or deficiency of the anal sphincters andanatomical and physiological factors (Macleod, 1983) Conservative treatement is indication in first degree pile while injection Sclerotherapy, photocoagulation, cryotherapy ,unipolar and bipolar diathermy, Banding and laser are indicated for the first and seconddegree piles. For the third and fourth degree piles conventional hemorrhoidectomy (Milligan-Morgan) still the standard operation but is associated with sever post-operative pain and this is the most important reason for patients to avoid hemorrhoidectomy (macrae and macleod 1995). Recently there is a new techniques for hemorrhoidectomy by Doppler guided hemorrhoidectomy by Doppler guided hemorrhoidal artery ligation discribed by morinaga et al (1995) and by the use of a modified circular stapling approach (PPH) initially described by longo (1998) these new techniques are quite easy and does not involve dissection and excision of the peri-anal skin and this undoubtedly associated with less post-opetrative pain.