Objective: To observe the effect of procedure for prolapse and hemorrhoids (PPH) and Ruiyun procedure for hemorrhoids (RPH) combined with external stripping and internal ligation on postoperative complications and pain in elderly patients with moderate to severe mixed hemorrhoids. Methods: A total of 63 elderly patients with moderate and severe mixed hemorrhoids treated by RPH combined with external stripping and internal ligation from January 2019 to December 2019 were selected as a control group. In addition, 63 elderly patients with moderate and severe mixed hemorrhoids treated with modified PPH combined with external stripping and internal ligation from January 2020 to December 2020 were selected as an observation group. The perioperative indexes, including operation time, intraoperative blood loss, hospitalization time, hospitalization expenses and wound healing time, of the 2 groups were recorded; Wexner score, maximum anal systolic pressure and maximum anal resting pressure were recorded before and 7 days after the operation. The Visual Analogue Scale (VAS) scores of the 2 groups were compared before the operation and 1, 3, 5 and 7 days after the operation; The complications of the 2 groups within 3 months were recorded. Results: Compared with the control group, the amount of bleeding in the observation group was less, the difference was statistically significant (P<0.05). After the operation, compared with the control group, the Wexner score of the observation group was lower, and the difference was statistically significant (P<0.05). There was no significant difference in the maximum anal systolic pressure and the maximum anal resting pressure between the 2 groups (P>0.05). Compared with the control group, the VAS score of the observation group was lower 1 and 3 days after the operation, and the difference was statistically significant (P<0.05). Compared with the control group, the total incidence of postoperative complications in the observation group was lower, and the difference was statistically significant (7.94% vs 20.63%, P<0.05). Conclusion: PPH combined with external stripping and internal ligation in the treatment of moderate and severe elderly patients with mixed hemorrhoids has, less impact on anal function, less postoperative pain, lower total incidence of complications, and less hospitalization expenses, which has promotion value.