Abstract: Objective To analyze the long-term efficacy and patient satisfaction of hemorrhoid artery ligation (HAL) with mucopexy in treatment of Ⅱ-Ⅲ degree hemorrhoids and explore the risk factors for recurrence. Methods One hundred and eighty patients with Ⅱ-Ⅲ degree hemorrhoids in our hospital from November 2013 to November 2014 were enrolled into this study and randomly divided into transanal hemorrhoidal dearterialization (THD) with mucopexy group (THDm group, 89 cases) and procedure for prolapse and hemorrhoids group (PPH group, 91 cases). The operative effect, complication, recurrence rate and patient's subjective satisfaction were observed. The risk factors for recurrence after THDm therapy were analyzed. Results Compared with PPH group, the average operation time was longer in THDm group [(37.2±6.8) min vs. (21.6±5.9) min, t=15.906, P<0.001]; the weight of resected tissue in THDm group was lighter [(3.6±1.6)g vs. (5.2±1.7)g, t=6.303, P<0.001]. In THDm group, the postoperative pain was lighter as compared with PPH group (t=14.485, P<0.001), average hospitalization days were significantly shorter than PPH group (t=15.585, P<0.001). There was no significant difference between the two groups in postoperative urinary retention and incidence of anastomotic stenosis, but the incidence of postoperative bleeding was lower in THDm group (χ²=4.305, P=0.038). However, recurrence of skin graft was higher than PPH group after THDm operation (χ²=4.681, P=0.031). The satisfaction of patients in THDm group was significantly higher than that in PPH group (Z=-3.757, P<0.001). And Ⅲ degree hemorrhoids and constipation were main risk factors of recurrence in patients undergoing THDm surgery (χ²=4.423, P=0.035; χ²=15.226, P<0.001). Conclusion THDm is an effective and safe therapy for Ⅱ-Ⅲ degrees hemorrhoids, but it has high recurrence rate, of which Ⅲ degree hemorrhoids and constipation are the main risk factors for postoperative recurrence.