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Management of hemorrhoidal disease is a tough task. First of all, because more than one surgical technique may be adequately indicated to manage different patients. Secondly, patients desire a good option associated with less postoperative pain, low morbidity, and good long-term results. In this setting, conventional excision of hemorrhoids is highly effective, besides being associated with postoperative pain and discomfort. For this reason, nonexcisional alternatives have been developed in order to reduce complications and to provide better postoperative recovery. To accomplish this aim, the Doppler-guided hemorrhoidal dearterialization with anopexy was been introduced into clinical practice with high expectations. This hope has been maintained mainly for the encouraging early results, and despite the possibility of late prolapse recurrence, especially in grade IV disease. Anatomical and clinical studies have demonstrated the THD efficacy in controlling symptoms and ameliorating quality of life. As it preserves anatomy, it causes no detrimental effect on the anorectal physiology, making functional disturbances mainly transitory and