Objective To evaluate the clinical effectiveness of automatic ligation (RPH) combined with polidocanol foam sclerosant in treating symptomatic circular prolapsed internal hemorrhoids.

Methods A retrospective selection was made in 82 patients with circumferential prolapsed internal hemorrhoids from January 2022 to March 2023 (observation group) who were treated with RPH combined with polidocanol foam sclerotherapy. Another 82 patients who underwent procedure for prolapse and hemorrhoids (PPH) surgery from January 2020 to December 2022 were chosen as control group. The differences in the incidence of perioperative complications, Visual Analogue Scale (VAS) scores, Barthel scores for activities of daily living, as well as the 1-year rates of rectal stenosis and recurrence were statistically compared between the two groups.

Results Compared with the control group, the observation group had a shorter surgical duration, a lower incidence of abnormal anal sensation, a faster decline in VAS score within 7 days postoperatively, and more significant pain relief, but a higher incidence of urinary retention, with statistically significant differences (P < 0.05). There were no statistically significant differences between the two groups in terms of surgical blood loss, postoperative anal swelling, delayed bleeding, Barthel score, stenosis rate, and recurrence rate (P>0.05).

Conclusion RPH combined with polidocanol foam sclerosant is superior to PPH in terms of effectiveness and safety in treating symptomatic circular prolapsed internal hemorrhoids, and has a shorter learning curve for operation. It can be applied to the clinical management of grade Ⅲ to Ⅳ circular prolapsed internal hemorrhoids.