Objective To explore the therapeutic effect of tissue selective therapy （TST） combined with anal epithelial preservation surgery on severe prolapsed hemorrhoids. Methods A total of 120 patients with severe prolapsed hemorrhoids admitted from January to December 2021 were divided into two groups according to random number table method, with 60 cases in each group. The observation group underwent TST combined with anal epithelial preservation, and the control group underwent external stripping and internal ligation. The operation time, intraoperative blood loss, anal distention, therapeutic effect, anal function （using Wexner scale, Vaizey scale, Pescatori scale, and AMS scale）, postoperative pain, incidence of postoperative complications, and quality of life of the two groups were compared. Results The surgical time, intraoperative bleeding, and anal distension score in the observation group were lower than those in the control group （P<0.05）. The effective rate of treatment in the observation group was higher than that in the control group （P<0.05）. The Wexner scale, Vaizey scale, Pescatori scale, and AMS scale scores of the observation group were lower than those of the control group （P<0.05）. The postoperative pain score and incidence rate of complications in the observation group were lower than those in the control group （P<0.05）. The quality of life score of the observation group was higher than that of the control group （P<0.05）. Conclusion TST combined with anal epithelial preservation has a significant effect on severe prolapsed hemorrhoids, with reduced patient pain, improved anal function, decreased complications, and elevated comprehensive quality of life. It can be referenced and promoted in clinical practice.