ObjectiveTo compare the efficacy and safety of automatic ligation of hemorrhoids (ALH) and procedure for prolapsed hemorrhoids (PPH) in the treatment of elderly patients with hemorrhoids. MethodsOne hundred and eighty elderly patients with hemorrhoids who were admitted into the First People's Hospital of Jining City from January 2012 to December 2014 were enrolled. According to the operative mode, the patients were divided into ALH group and PPH group, with 90 cases in each group, received ALH and PPH treatment respectively. The postoperative pain, urinary retention, edema, bleeding, infection, anal swelling and anal stenosis were observed in the two groups, and two methods of operation were evaluated in terms of operation time, intraoperative bleeding, postoperative bleeding, postoperative pain, healing time, hospitalization expenses and postoperative complications. ResultsThe VAS scores of the ALH group in the day 1-3 after operation were lower than that of the PPH group, the difference was statistically significant (P < 0.05); the frequency of the use of analgesics in ALH group was less than that in PPH group (P < 0.01); the amount of blood loss and the healing time of the ALH group were significantly less or shoter than those of the PPH group (P < 0.01); the incidence of postoperative urinary retention in the ALH group was 2.22% (2/90), which was significantly lower than that of the PPH group, 27.78% (25/90), the difference was statistically significant (χ2=23.050, P=0.000); the incidence of perianal edema after operation in the ALH group was 5.56% (5/90), which was significantly lower than that of PPH group of 15.56% (14/90), the difference was statistically significant (χ2=4.766, P=0.029). There was no obvious postoperative bleeding in the ALH group(0/90), while the incidence of postoperative bleeding in the PPH group was 7.78% (7/90), and the difference between the two groups was statistically significant (Fisher's exact test, P=0.007). The efficiency of ALH group was 98.89% (89/90) and the PPH group was 97.78% (88/90), the difference between the two groups was not statistically significant (χ2=0.339, P=0.560). Conciusions There is no significant difference between ALH and PPH in the treatment of elderly patients with hemorrhoids, but ALH has the advantages of less pain, quicker recovery and fewer complications, it is worthy of popularization and application.