The aim of this study was to assess the medical treatment in comparison with hemorrhoidectomy in the management of primary grade-4 internal hemorrhoidal disease (IH) and external hemorrhoidal disease (CH). Group I (medical treatment): 127 patients (59 IH, 68 CH) were prospectively collected and medically treated using oral tablet of micronized purified flavonoid fraction (MPFF) containing 450 mg of diosmin and flavonoids expressed as 50 mg hesperidin, with dosage of 6 tablet per day for 4 days, 4 tablet per day for 3 days, and 2 tablet per day until the signs and symptoms clinically disappear or the end of observation time of 6 weeks. Group II (hemorrhoidectomy): 119 post-hemorrhoidectomy patients (50 IH and 69 CH) were observed with respect to postoperative bleeding, pain, urinary retention, soiling, constipation, recurrence. Statistical calculation using chi-square test to compare the sign and symptom of Group I and Group II. In Group I: the hemorrhoidal piles, bleeding, pain and oozing were progressively decreasing, and all complaints finally disappeared between 1 and 6 weeks without any MPFF’s adverse reaction. In Group II: postoperative bleeding, pain, soiling, urinary retention, and constipation were noted. It showed as ignificant outcome in Group I in comparison with Group II (bleeding, p=0.012; pain, p=0.000), soiling, urinary retention, anal stenosis and constipation.

internal hemorrhoidal disease, external hemorrhoidal disease, medical treatment, hemorrhoidectomy, flavonoid