A 45-year-old man presents with prolapsing hemorrhoids that reduce spontaneously after defecation. On examination, the hemorrhoids are enlarged, prolapse with straining, but reduce without manual reduction. According to the Goligher classification, what grade are these hemorrhoids, and what is the most appropriate initial treatment?

• A Grade II: rubber band ligation
• B Grade IV: hemorrhoidectomy
• C Grade III: hemorrhoidectomy
• D Grade III: rubber band ligation ✓

Explanation

Grade III hemorrhoids prolapse with straining and require manual reduction or reduce spontaneously. The description fits Grade III (prolapse that reduces spontaneously or with manual reduction). Rubber band ligation is effective for Grade II and III hemorrhoids. Hemorrhoidectomy is reserved for Grade IV (irreducible prolapse) or failed conservative measures. Grade I do not prolapse.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

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