A 48-year-old woman has long-standing internal haemorrhoids that now prolapse permanently and cannot be manually reduced, with recurrent bleeding and soilage. Examination confirms circumferential fourth-degree piles without gangrene. What is the definitive treatment of choice?

• A Rubber band ligation
• B Excisional haemorrhoidectomy (Milligan-Morgan) ✓
• C Injection sclerotherapy
• D Stapled haemorrhoidopexy as the only accepted option

Explanation

Excisional haemorrhoidectomy remains the gold standard and the most effective definitive treatment for grade III to IV haemorrhoids, giving the lowest recurrence rates. Rubber band ligation and sclerotherapy are office procedures suited to grade I to II disease and fail for permanently prolapsed, irreducible piles. Stapled haemorrhoidopexy is a valid alternative for circumferential prolapse but is not the only accepted option, and its recurrence rate exceeds that of excisional surgery.

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.