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<p><strong>Background and Objective</strong>: Post-operative pain and complications are common after open haemorrhoidectomy. Addition of internal sphincterotomy has shown to improve the post-operative outcomes. This study is conducted to compare the outcomes of open haemorrhoidectomy with and without internal sphincterotomy.<br /><strong>Methods:</strong> A prospective randomized controlled trial was conducted in the Department of Surgery at Sargodha Medical College/District Headquarter Hospital, Sargodha from February 2016 to December 2017. One hundred and twenty-two patients presenting with third and fourth degree haemorrhoids were divided in two equal groups. In group &ldquo;A&rdquo;, haemorrhoidectomy with internal sphincterotomy and in group &ldquo;B&rdquo;, haemorrhoidectomy alone was performed. Outcome variables such as pain scores based on Verbal Rating Scales (VRS), hospital stay, complications and wound healing were compared in both groups.<br /><strong>Results:</strong> The mean pain scores were less in the internal sphincterotomy group A i.e., 3.3 &plusmn; 0.3 while it was 3.6 &plusmn; 0.4 in group B at 1st post-op day. The mean duration of hospital stay was less in group A (2.3 &plusmn; 0.7 days) and it was 3.4 &plusmn; 0.9 days in group B. On the 7th post-operative day, 13 (21.3%) patients in group A and 4 (6.6%) patients in group B had flatus incontinence. Urinary retention was present in 4 (6.6%) cases in group A and 13 (21.3%) in group B. Post-operative bleeding was present in 44 (72.1%) cases of group A and 41 (67.2%) of group B. Constipation was higher in the group B (44.3% vs. 37.7%). Wound healing was better in group A (63.3%). Anal stenosis occurred in 3 (4.9%) patients who were treated with&nbsp;<br />haemorrhoidectomy alone.<br /><strong>Conclusion:</strong> Addition of internal sphincterotomy improves the outcome of open haemorrhoidectomy in patients of third- and fourth-degree haemorrhoids. It is therefore recommended to carryout internal sphincterotomy when operating on such patients</p>