Background: Haemorrhoidectomy is a definitive treatment for severe haemorrhoids, but it can be associated with significant postoperative pain and delayed recovery. Lateral internal sphincterotomy has been proposed to alleviate these issues, though its efficacy and safety remain subjects of debate.Methods: This observational study involved 80 patients who were randomly assigned to undergo either haemorrhoidectomy alone (Group A, n = 40) or haemorrhoidectomy with lateral sphincterotomy (Group B, n = 40). Data on postoperative pain, recovery time, complications, recurrence of haemorrhoids, and patient satisfaction were collected and analysed. The primary outcomes were measured using the Visual Analog Scale (VAS) for pain and recurrence rates at 6-month follow-up.Results: Group B patients experienced significantly lower postoperative pain at 24 hours, 72 hours, and 1 week (p < 0.001) compared to Group A. The time to return to normal activities was also shorter in Group B (10 ± 2 days vs. 14 ± 3 days, p < 0.05). Complication rates were similar between the groups, but Group B had a slightly higher incidence of fecal incontinence (5% vs. 0%). Recurrence of haemorrhoids was less frequent in Group B (2.5% vs. 7.5%).Conclusion: Haemorrhoidectomy with lateral sphincterotomy reduces postoperative pain and accelerates recovery compared to haemorrhoidectomy alone. Despite the increased risk of fecal incontinence, the combined procedure may offer superior overall outcomes for patients with advanced haemorrhoids. © 2025 Elsevier B.V., All rights reserved.