Hemorrhoidectomy in Patients With Grade III and IV Disease:Harmonic Scalpel Compared With Conventional Technique

Inclusion Criteria: * Patients between age 20-60 years, both male and female with III and IV degree hemorrhoids diagnosed during last 1 year. Exclusion Criteria: * • Patients with permenantly prolapsed hemorrhoids limited to one quadrant only and had been assessed on per rectal examination and proctoscopy * Any other anorectal pathology such as anal fissure ,fistula or anal cancer on history and per rectal examination * Previous anal surgery assessed by history and per rectal examination * Inability to give informed consent * ASA grade III/IV on detailed history, clinical examination and laboratory findings e.g. deranged hepatic(AST/ALT \>40IU/L) and renal profile ( creatinine \>1:2mg/dl)and evidence of ischemic heart disease(annexure attached).