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This surgery does not remove the hemorrhoids, but rather the expanded hemorrhoidal supporting tissue that has allowed the hemorrhoids to slip downward. This procedure involves several steps: A circular, hollow tube is inserted into the anal canal and a suture (a long thread) is placed through it and woven circumferentially within the anal canal above the internal hemorrhoids. The ends of the suture are brought out of the anus through the hollow tube. The stapler is placed through the hollow tube and the ends of the suture are pulled, expanding the hemorrhoidal supporting tissue into the jaws of the stapler. The hemorrhoidal cushions are pulled back up into their normal position within the anal canal.