Background: The best surgical method for hemorrhoidectomy is still unknown; hence innovative procedures like harmonic scalpel hemorrhoidectomy and stapled hemorrhoidectomy need to be researched. Objective: The aim of this work was the selection of best method of treatment of third and fourth degree primary haemorrhoids. Patients and methods: The present clinical trial included 36 patients with the diagnosis of symptomatic 3rd and 4th degree primary hemorrhoids, admitted to the Department of General Surgery, Zagazig University Hospitals for surgical management. The patients were divided equally into Group 1 who underwent Stapled hemorrhoidopexy, and Group 2 who underwent harmonic scalpel hemorrhoidectomy. All patients in both groups were followed up weekly for the first 4 postoperative weeks. Postoperative pain, fecal incontinence, time of complete healing, and early recurrence were evaluated. Results: Postoperative pain was less in the Stapler group with significantly difference from the harmonic group. Fecal incontinence was higher in harmonic group but with no statistically significant difference from Stapler group. Healing and return work were significantly higher among Stapler group with no significant difference from harmonic group. Regarding early recurrence, Stapler group had two cases, while harmonic group had only one case with no statistically significant difference between both groups. Conclusion: Stapled hemorrhoidopexy had better results than harmonic scalpel hemorrhoidectomy because it was associated with less postoperative pain, less fecal incontinence and less incidence of wound complications.