Many treatment options are now available for treating hemorrhoidal disease including: diet and life-style modification, medical treatment, office-based procedures, non-excisional surgery and conventional excisional surgery. Rubber band ligation is the most commonly used office-based procedure. Manual hemorrhoidopexy is a relatively novel technique for treating hemorrhoidal disease. It varies from hemorrhoidal course ligation procedure, as it includes ligation of hemorrhoidal vessels as well as plication and height with obsession of the prolapsing hemorrhoids. The point of the investigation is to contrast attractions elastic band ligation and manual hemorrhoidopexy in treatment of hemorrhoidal infection. This is a planned report included patients enrolled from the outpatient center of colorectal medical procedure unit, Benha University Hospital. The investigation incorporated an aggregate of 80 grown-up patients analyzed as second and third degree butt-centric hemorrhoidal infection. Patients were haphazardly (shut envelope technique) partitioned into two gatherings (An and B). Gathering (An) included 40 patients rewarded by elastic band ligation though Group (B) included 40 patients rewarded by manual hemorrhoidopexy (MH). Enrolment of qualified patients started on September 2013 and occurred till September 2017. Follow up was intended for two years length until September 2019. There was no measurably noteworthy contrast between the two gatherings as respect segment models, boss grumbling, length of indications, and level of hemorrhoids. There was a measurably critical distinction between the two gatherings as respect time of technique which was shorter in gathering (A). Additionally, seeping during the technique was less in gathering (A) with a measurably noteworthy contrast. A shorter emergency clinic remain and increasingly fast come back to work were seen in gathering (A) with a profoundly huge contrast. The VAS torment score was higher in gathering (B) with a critical distinction. Repetitive pace of hemorrhoidal ailment was altogether higher in patients with third degree heaps rewarded with elastic band ligation than those rewarded with manual hemorrhoidopexy. Elastic band ligation has better result primarily in second degree hemorrhoidal ailment while manual hemorrhoidopexy is related with less repeat rate in third degree hemorrhoidal illness.