A 42-year-old woman has symptomatic internal haemorrhoids that prolapse on straining and require manual reduction, but are not permanently prolapsed. There is no significant bleeding. Which procedure is most appropriate?
- A Rubber band ligation
- B Excisional haemorrhoidectomy ✓
- C Injection sclerotherapy
- D Stapled haemorrhoidopexy
Correct answer: B. Excisional haemorrhoidectomy
Explanation
Grade III haemorrhoids prolapse and require manual reduction. Excisional haemorrhoidectomy (Milligan-Morgan open or Ferguson closed) is the most effective and durable treatment for grade III and IV disease. Rubber band ligation and sclerotherapy are appropriate for grade I and II piles but have high failure rates once prolapse requires manual reduction. Stapled haemorrhoidopexy treats circumferential prolapse but has higher recurrence than excisional surgery for established grade III disease.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.