Surgical management of haemorrhoids: an Italian survey of over 32 000 patients over 17 years by Altomare et al. 1 The authors present one of the largest series of prospectively maintained data from 32 458 patients treated for haemorrhoids during a 17-year period (2000–2016) in several Italian referral centers. It included the era of PPH at the beginning of the 2000's and the rise of the novel non-resection haemorrhoidal treatments at the turn of the 2010′s. The Doppler-guided haemorrhoidal artery ligation alone procedure had unacceptably high recurrence rates for high grade haemorrhoids of up to 30% 2. With the addition of the mucopexy component (rectoanal repair) it replaced stapled haemorrhoidopexy as the number two technique in the treatment of grade III haemorrhoids. The authors report that non DG-HAL techniques have gained in popularity which make the procedure less costly. Abandoning the Doppler proctoscope which had a questionable benefit for the success of this technique was already demonstrated by our own group and others 3. The return to a conventional haemorrhoidectomy technique confirmed in the eTHOS trial for higher grade haemorrhoids (grade III and IV) parallels European strategies in the treatment of the most common proctological disorder in our daily practices and fits into recent guideline developments by the ESCP (https://www.escp.eu.com/guidelines#haemorrhoids).