In their letter, Brisinda et al take issue with the use of postoperative pain as an outcome measure in studies on haemorrhoid surgery including in our trial. However, as despite the technical differences between stapled anopexy and excisional haemorrhoidectomy, pain remains an important outcome measure in treatment of haemorrhoids, especially from the patient’s perspective. A glance at the history of treatment of haemorrhoids would suggest that the notoriety surrounding surgery for haemorrhoids stems from the significant postoperative pain following excisional haemorrhoidectomy and indeed this fact more than anything else drove the desire for alternative procedures including stapled anopexy. …