PURPOSE: A modified technique of pile suture (PS) was introduced with its principle and useful indications. METHODS: A transfixing suture was layed onto the base of hemorrhoidal cushion including vessels, submocosal connective tissues, and internal anal sphincter. According to morphological changes in the pile, several (0~2) sutures were added downward upto the level of the dentate line. We have treated 348 patients with third and fourth degree hemorrhoids by either this technique alone (28 patients) or by combination with other techniques (320 patients). The median follow-up period was 39 months. RESULTS: This technique showed earlier convalescence and lesser complications than the open hemorroidectomy (OH) (p<0.05): PS vs. OH, hospitalization 2.3 vs. 4.7 days; pain, 4.2 vs. 6.9 days; discharge, 0 vs. 8.6 days; dripping amount of bleeding, 3.8% vs. 13.9%. There was no recurrence in both operative techniques. CONCLUSIONS: Because hemorrhoids present diverse shapes and symptoms, various operative techniques may be more efficient than single technique alone. Pile suture appears to be an useful armamentarium in treating hemorrhoids, especially in cases of recurrent or multiple hemorrhoids.