Traditional surgical excision Traditional surgical excision is the ligature removal or circumferential removal of a single hemorrhoid. It is indicated for patients with grade III and IV, external hemorrhoids with thrombosis, those with ulcers, fissures, fistulas and those who have been treated but continue to have severe symptoms. Advantages: good efficacy, relatively low recurrence rate and low cost. Disadvantages: very painful after surgery, many complications, slow recovery and long hospital stay. Suprahemorrhoidal loop (PPH surgery) The suprahemorrhoidal loop is a circular excision of the prolapsed rectal mucosa above the hemorrhoid using a special instrument called a “PPH clutch”. During the operation, the anus is first opened and the rectal mucosa is circumferentially sutured at about 4 cm above the dentate line (the junction line between the rectum and the anal canal). It is suitable for Grade III, Grade IV and some severe Grade II hemorrhoids, but not for people with severe external hemorrhoids and anal stenosis. Advantages: short surgery time, less pain, quick recovery. Disadvantages: Expensive.