Fig. 1

Procedure of Ruiyun procedure for hemorrhoids combined simplified Milligan–Morgan hemorrhoidectomy with dentate line-sparing. A Circumferential prolapsed hemorrhoids with skin tags. Check the number and size of the hemorrhoids above the dentate line (B) and the loose mucosal part (C). D–F Ruiyun procedure for hemorrhoids (RPH): suction aiming at the internal hemorrhoid or loose mucosa, turned off the negative pressure after the elastic suture ring ligated the internal hemorrhoid or loose mucosal at − 0.08 to − 0.1 MPa with the elastic line fully tighten around the hemorrhoids or loose mucosal (D), and then remove the bandage (E).the prolapse has been significantly improved (F). G–I Simplified Milligan–Morgan procedure (sMMH): check the number and size of the hemorrhoids below the dentate line with a horn-shaped anoscope (G). A radial fusiform incision was made from the lower edge of the external hemorrhoids to the dentinal line, then striped the subcutaneous tissue and vein cluster, and the inverted "v" shape was formed near the dental line (H). Clamping the base, then ligate and remove the hemorrhoids (I)