INTRODUCTION: Despite all developments in the recent years, the choice of an adequate treatment for hemorrhoids remains a problem. The hemorrhoidopexy as described by Longo and the Doppler-guided hemorrhoidal artery ligation follow a concept different from the excision and destruction techniques from earlier years. In both techniques, the hemorrhoidal tissue is preserved, as it may be important for anal sensation and continence. The high costs of the circular stapler gun and the Doppler methods can probably be overcome by the proposed technique, a transanal open hemorrhoidopexy, while simultaneously preserving hemorrhoidal tissues. METHODS: Between November 2006 and May 2007, 38 patients with third-degree hemorrhoids were treated with open transanal hemorrhoidopexy. All patients were positioned in the lithotomy position and operated under general anesthesia; the anal mucosa was stitched to the rectal wall with four Z-stitches after removal of a small rectal mucosa flap about 4 cm from the dentate line. The four stitches were circumferentially positioned at equal distances. Postoperatively, the patients followed a fiber-rich diet for one week. RESULTS: Most patients (n = 32, 84 percent) were without any complaint upon follow-up at one week. Six patients (16 percent) experienced pain and were treated with oral analgesics. One patient (3 percent) experienced minor bleeding that stopped spontaneously. After one month follow-up, 34 patients (89 percent) had no symptom complaints. Two patients (5 percent) experienced segmental prolapse and two patients (5 percent) had remaining pruritus. No patient needed another intervention. CONCLUSION: The proposed operation, transanal open hemorrhoidopexy, appears to be an effective technique. The procedure can be performed under direct vision and is very cost effective compared to the other hemorrhoidal tissue-sparing procedures.