what is the best surgical procedure for this patient with grade 4 hemorrhoids

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In this situation there is no need for emergency surgery.lst of all reduce oedema with sitz bath and meg sulf dressing & later on hemorrhoidectoy with the help of forced triad.
I suggest to decrease the edema 're assess and go for surgery
intial apply glycerine mag sulphate and surgery
surgical haemorrhoidectomy
stapler hemorrhodectomy
Dr Drnutan Brave's opinion is totally applicable .No haste for emergency surgery .Intermittent sitz bath will be very much help full.some oral medication may help in rapid regression before surgery .
Agree with dr barve fist do proper glycerin mgso4 dressing reduce edema than surgical hemorroidectomy i say miph steppler can be done with expert hand provided pt do not having cost issue
I would like to do a satisfactory Lord's dilatation 4to6 finger so. This makes the haemorrhoids shrink to a great extent .Residual masses can be dieted ligated and excised.
initially apply glycerinemagsulf dressing to protrtuded mass , so as to reduce the mass then reassess the case by P/R and P/ SP ,I will prefer surgical haemorrhoidectomy.
dr bhat - lord's dilatation is a redundant procedure. leads to more fissures. this pile mass can be reduced when you give spinal and proceed with stapler hemorrhoidopexy
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