Background and aim: To compare clinical and anal manommteric effects of ligation excision surgery for haemorrhoidal 
disease to that of pile suturing. 
Patients and methods: The study included 45 patients with haemorrhoids. They were randomised to either undergo the pile suture technique (Ps) or ligation and excision haemorrhoidectomy (Le). Clinical and manommetric assessment of all patients was performed preoperatively and at 6 weeks and 3 months postoperatively. A control group of 20 volunteers free of anal disease was included to establish the normal anal manometric values. 
Results: Patients in the Ps group had significantly less postoperative pain. Two (8.7%) patients required narcotic analgesics in the Ps group in comparison to 12 (54.55%) in the Le group (Fisher's exact test: p < 0.01). The time to the first bowel motion and hospital stay was significantly shorter in the Ps group (Unpaired t test: p < 0.01). Two patients in the Le group suffered from incontinence to liquid stools at 6weeks The resting anal pressure significantly decreased after surgery in both groups (Paired t test: p < 0.01). The squeeze anal pressure and vector symmetry index decreased significantly only in Le group (Paired t test: p < 0.05). 
Conclusion: Ligation excison operation is traumatic and it is recommended to use more conservative operations such as the pile suture in the management of patients with haemorrhoidal disease and strongly recommend its inclusion in the training programmes of Egyptian surgeons.