Which surgical treatment is most commonly used for grade III and IV internal hemorrhoids?

For grade III and IV internal hemorrhoids, the most commonly used surgical treatment is closed hemorrhoidectomy. This procedure involves the complete excision of the hemorrhoids and surrounding tissues, which is particularly effective for higher-grade internal hemorrhoids that are larger and more symptomatic.

Grade III hemorrhoids are those that prolapse and can be manually reduced, while grade IV hemorrhoids are permanently prolapsed and cannot be pushed back in. The closed hemorrhoidectomy method allows for a more controlled and precise surgical approach compared to open techniques, thereby minimizing postoperative complications such as pain and bleeding.

Rubber band ligation, injection sclerotherapy, and open hemorrhoidectomy are typically reserved for lower-grade hemorrhoids (grades I and II) or specific cases where less invasive measures do not suffice. These methods might not provide adequate results for higher grades due to the severity of symptoms and the anatomical changes associated with prolapse. As a result, closed hemorrhoidectomy remains the recommended treatment option for managing grade III and IV internal hemorrhoids effectively.