The aim of this study was to compare the outcome of patients receivinghemorrhoidectomy using ultrasonic coagulation, conventional hemorrhoidectomy. Twenty patients with grade 3 o 4 piles were randomly assigned to receive1)Modified Milligan-Morgan hemorrhoidectomy using scissors excision-ligation techniquefollowed by hemostasis using diathermy or 2) Ultrasonic coagulation hemorrhoidectomy. Thepatient were not aware of the technique used at operation. Patients were followed up weeksafter operation. The measured outcomes included 1) operation time; 2) blood loss; 3)postoperative hospital stay; 4) pain score; 5) wound healing duration 6)wound infection. There was high statistical difference between ultrasonic coagulation conventionalhemorrhoidectomy regarding intraoperative blood loss , operative time , wound healing andduration , post operative pain in day 1 & 2 , no difference was shown in post operative pain after1 week. The study shows that the ultrasonic coagulation is superior to the conventionalhemorrhoidectomy regarding intraoperative blood loss , operative time , wound healing and earlypost operative pain.