AIM: The occurrence of mixed hemorrhoids becomes increasingly more frequent with age, posing psychological pressure and distress to affected patients. This retrospective study aims to compare the clinical efficacy of automatic Ruiyun procedure for hemorrhoids and procedure for prolapse and hemorrhoids in the treatment of mixed hemorrhoids. METHODS: A retrospective cohort study of patients with mixed hemorrhoids who visited the Third Affiliated Hospital of Gansu University of Chinese Medicine (The 1st People's Hospital of Baiyin) from January 2019 to December 2023 was conducted using propensity score matching (PSM) with a ratio of 1:1 for nearest neighbor matching grouping. In this study, 60 cases were grouped under the Ruiyun procedure for hemorrhoids (RPH) group, and the other 60 cases were categorized in the procedure for prolapse and hemorrhoids (PPH) group. The postoperative medical humanistic evaluation, clinical efficacy evaluation, subjective evaluation of patients, the occurrence of complications and the rate of unplanned readmission were compared between the two groups. RESULTS: Surgical time, intraoperative blood loss, duration of postoperative pain, length of hospital stay and hospitalization expenses between the two groups presented statistically significant differences (p < 0.001). There were statistically significant intra-group and between-group differences between RPH group and PPH group in the visual analogue scale (VAS) scores on the 4th and 6th postoperative days (p < 0.001). The European Quality of Life-5 Dimensions, 5-Level Version (EQ-5D-5L) score in the RPH group was lower than that in the PPH group at the 12th week of follow-up (p 0.05). The rate of unplanned postoperative readmission was higher in the PPH group than in the RPH group, although the difference was not of statistical significance (p > 0.05). CONCLUSIONS: RPH outperforms PPH in the treatment of mixed hemorrhoids with a shortened surgical time.