The efficacy of selective malposition ligation combined with hemorrhoid and fistula I prescription and the improvement of complications were assessed to improve surgical efficiency and safety.423 patients undergoing complex mixed hemorrhoid surgery at different time points were included as research objects and enrolled into group A (malposition ligation), group B (selective malposition ligation), and group C (selective malposition ligation and hemorrhoid and fistula I), each with 141 cases.The scores for visual analogue scale (VAS), edema, and hemorrhage of group C 8h, 1 day, 2 days, 3 days, 5 days, and 7 days after surgery were all inferior to those in groups A and B, while that of group B was inferior to that in group A (P < .05). The duration of wound healing of group C (15.33 ± 2.78 days) was shorter than that of groups A (21.78 ± 3.22 days) and B (18.34 ± 3.01 days), and this duration of group B was shorter than that of group A (P < .05). The total effective rate of group C (96.45%) was superior to that of groups B (96.45%) and A (82.27%). The total effective rate of group B was superior to that of group A. The falling-off rate of the rubber ring in groups C and B was inferior to that in group A. The incidence of total complications in group C (9.93%) was inferior to that in groups B (30.50%) and A (30.50%), while that of group B was inferior to that in group A (P < .05).After selective malposition ligation, the oral intake of hemorrhoid and fistula I could promote the recovery of wounds among patients with complex mixed hemorrhoids and reduce the incidence of postoperative hemorrhage and edema. Hence, it has significant clinical application values.