Background: Hemorrhoidal disease is a common anorectal condition affecting approximately 40% of the population. Routine histopathological examination of excised hemorrhoidal tissue is debated, with some studies recommending it for all cases, while others suggest it only when clinical suspicion is present. This study aims to evaluate the necessity of routine histopathological examination following hemorrhoidectomy. Methods: A retrospective analysis was conducted on 1227 patients who underwent hemorrhoidectomy at Van Training and Research Hospital and Amasya University Sabuncuoglu Serefeddin Training and Research Hospital between January 1, 2015, and December 31, 2024. Patient data, including age, gender, and pathology results, were reviewed. Results: Of the 1227 patients, 863 (70.3%) were male, with a mean age of 41.3 years. Pathological examination revealed no malignancy; however, 1 case of tubulovillous adenoma and 1 case of high-grade squamous intraepithelial lesion (AIN 3) were detected. A total of 1211 patients had hemorrhoids, while other benign and premalignant lesions were also found incidentally. Discussion: Routine histopathological examination after hemorrhoidectomy is controversial, with studies indicating low malignancy rates. Some experts advocate for examination in high-risk patients or when clinical suspicion is raised. This study supports the need for histopathological examination in such cases, although further research is required to establish clear guidelines. Routine histopathological examination after hemorrhoidectomy may be unnecessary for most patients, but should be performed in cases with clinical suspicion or specific risk factors to enhance cost-effectiveness and reduce unnecessary interventions.