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Introduction: Haemorrhoid is a common surgical condition occurring in 4.4% of adults with a peak prevalence between 45 and 65 years of age. A haemorrhoidectomy is the standard treatment for patients with grade III or IV internal haemorrhoids. Recently Harmonic scalpel has been used for haemorrhoidectomies, since it reduces operative bleeding. The present study was conducted to analyse and compare outcomes of haemorrhoidectomies performed with an ultrasonic scalpel and monopolar electric cautery. Material and Methods: The present study was carried out at a tertiary care centre over a period of two year from October 2017 to October 2019. A total of 60 patients, with history suggestive of haemorrhoids were screened and those diagnosed with grade III or grade IV haemorrhoids were enrolled in the study. The patients were randomised to either Group A (haemorrhoidectomy using electrocautery) or Group B (haemorrhoidectomy using Harmonic scalpel). Milligan-Morgan open hemorrhoidectomy using electrocautry and harmonic scalpel were performed as per the group. Observations: The most common age group to be involved was 31-40, 23 patients (38.3%). Males were affected more than females, with a male to female ratio of 7.6:1. The primary presenting symptom was painless bleeding per rectum in 44 patients (73%) and prolapse was seen in 33 patients (55%). 29 patients (48.3%) had grade III and 31 patients (51.7%) had grade IV haemorrhoids. Post-operative bleeding was significantly less in harmonic scalpel haemorrhoidectomy [ 3(10%), 8(26.7%), p =0.04]. Post-operative pain was significantly greater in the conventional electrocautery group as compared to the harmonic scalpel group on post-operative days 1,5 and14. Conclusion: It can be concluded that Scalpel approach have reduced pain in immediate post-operative period and at 24 hours with fewer analgesics required. We strongly advocate the use of Harmonic Scalpel devices for haemorrhoidectomy when and where possible, especially for high grade. [ABSTRACT FROM AUTHOR]