A 42-year-old woman has grade III internal haemorrhoids causing recurrent bleeding and prolapse that she can reduce manually after each defecation. Conservative measures and two sessions of rubber band ligation have failed. What is the most appropriate next step?

• A Continued rubber band ligation until resolution
• B Excisional haemorrhoidectomy ✓
• C Injection sclerotherapy with 5 percent phenol in almond oil
• D Stapled haemorrhoidopexy is contraindicated in all circumferential disease

Explanation

Grade III haemorrhoids prolapse and require manual reduction; when band ligation fails, excisional haemorrhoidectomy remains the gold standard with the lowest recurrence rate. Injection sclerotherapy suits grade I disease unsuitable for banding. Stapled haemorrhoidopexy is not contraindicated in circumferential prolapse; it is in fact designed for circumferential grade III disease, though excisional techniques give lower recurrence, which makes option D false as worded.

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

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Written and medically reviewed by the StethoPrep medical team.