BACKGROUND:Haemorrhoids are one of the most frequent anorectal disorders encountered in the primary care setting. Heamorrhoidectomy is the procedure of choice. Harmonic scalpel had been advocated for performing bloodless Haemorrhoidectomy, in place of electric cautery and ligatures. AIM: The aim of this study is to compare Harmonic scalpel Haemorrhoidectomy with conventional M. M. Haemorrhoidectomy using electric cautery in the management of grade III and grade IV haemorrhoids with reference to certain characteristics like postoperative pain, complications, hospital stay, cost of surgery. METHODS AND MATERIALS: This is a randomized single blind control study with 50 patients divided into two groups. 25 patients underwent M. M. Haemorrhoidectomy (M. M. Group), and rest underwent Harmonic scalpel Haemorrhoidectomy (H. S. Group). Results were compared in relation to certain characteristics like perioperative bleeding, postoperative pain and complications, hospital stay, cost of surgery. RESULTS: Age and gender wise distribution in both groups is comparable. Intraoperative bleeding was more frequent in the MM group than in HS group (32% versus 16% respectively). Intraoperative bleeding was more frequent in the MM group than in HS group (32% versus 16% respectively). Hospital stay was prolonged in the MM group than HS group, as 44% in MM group were discharged at three days, when compared to 76% in HS group. CONCLUSION: Harmonic scalpel haemorrhoidectomy had better outcome in characteristics like postoperative pain, post-operative complications, hospital stay, but its more expensive than conventional M. M. Haemorrhoidectomy. KEYWORDS: Harmonic scalpel, Haemorrhoidectomy, Milligan Morgan. INTRODUCTION:Haemorrhoids are one of the commonest anorectal disorders encountered in general surgical practice. They are the most common cause of bleeding per rectum and responsible for considerable patient suffering and disability. (1) Haemorrhoidectomy is the treatment of choice for grade III and grade IV Haemorrhoids. Post-operative course after haemorrhoidectomy will be protracted and painful. Different surgical techniques and use of recent advancements in instrumentations like Harmonic scalpel, Ligature and circular stapler (PPH) had been advocated for better outcome and to minimize perioperative bleeding and post-operative pain.Harmonic scalpel is an ultrasonically activated instrument, which vibrates at a rate of 55,000 HZ per second. It generates less temperature during tissue dissection and controls bleeding by coacptive coagulation at low temperatures ranging from 50 o C to 100 o C. Coagulation occurs by means of protein denaturation when the blade vibrating at 55000 HZ, couples with protein, denaturating it to form a coagulum that seals small coapted vessels. When the effect is prolonged, secondary heat is produced that seals larger vessels.By contrast, electro surgery and lasers coagulate by burning (Obliterative coagulation) at higher temperatures (150 o C to 400 o C). Blood and tissue are desiccated and oxidiz...