Purpose <p>This study aimed to evaluate the efficacy and safety of a modified sclerobanding (mSB) procedure, which combines rubber band ligation (RBL) with 3% polidocanol foam sclerotherapy (PFS), for treating grade II/III hemorrhoidal disease (HD).</p> Methods <p>We retrospectively included patients with grade II/III HD who underwent RBL from January to December 2021 and mSB from January 2022 to February 2023 at Ningbo Medical Center Lihuili Hospital. The primary outcomes assessed were treatment failure rates and the incidence of delayed massive bleeding (DMB), while the secondary outcomes included postoperative complications such as pain, swelling, anal edema, and variations in bleeding grade. Long-term follow-up evaluated the HD Symptom Score (HDSS), Short Health Scale for HD (SHS-HD), and Patient Satisfaction (PS).</p> Results <p>Among the 307 patients, 162 received mSB and 125 underwent traditional RBL. The baseline characteristics were similar, except for the anticoagulant history and hospital stay length (<i>P</i> &lt; 0.05). The mSB group had no cases of delayed major bleeding, compared to five cases in the RBL group. The recurrence (6.8% vs. 17.0%) and treatment failure (6.8% vs. 18.6%) rates were significantly lower in the mSB group (<i>P</i> &lt; 0.05). Postoperative complications were comparable between the groups, but the mSB group showed greater improvement in bleeding by the seventh day (<i>P</i> &lt; 0.05). One-year follow-up revealed no significant differences in the HDSS, SHS-HD, or PS.</p> Conclusions <p>The modified sclerobanding procedure reduces the number of ligation sessions, lowers the risk of delayed bleeding, and decreases treatment failure rates without increasing the risk of postoperative complications.</p>