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The choice of adequate treatment for hemorrhoids still remains aproblem. Like Longo's hemorrhoidopexy, transanal open hemorrhoidopexy (TOH) follows a concept, thatpreserves hemorrhoidal tissue. This study examines the results of TOH in a period of 3 years.Between November 2006 and April 2010, 162 patients were treated with TOH. In lithotomy position and under general anesthesia the distal rectal mucosa was lifted and fixed by Zstitches four centimeters above the hemorrhoidal basis after removal of a small rectal mucosa flap. The Z-stitches were positioned in up to four segments dependent on the size of theprolapse.One hundred and thirty-six patients (84%) were without any complaint at 1 week. Twentysix patients (16%) experienced pain and were treated with oral analgesics. Five patients (3%) experienced minor bleeding that stopped spontaneously. One hundred and twenty-eight patients (79%) had no further complaints during complete follow up. A new segmentalprolapse was noticed in 19 patients (11%) and was treated by a second TOH in seven patients (4%). Twenty patients (12%) hadpruritus ani.TOH appears to be an effective technique over a period of 3 years. Theprocedure can be performed easy, under direct vision and is very cost effective.