Dr Cariati's comments on the cost of stapled hemorrhoidpexy are certainly interesting, since in the current era of worldwide recession, the economic implications of any new technology and its impact on the health care system are extremely important. Our study, however, was not intended to be an economic evaluation of the 2 procedures, and therefore costs were not part of the parameters analyzed. However, when calculating the financial cost of any surgical treatment and, even more importantly, its overall societal costs, it is necessary to consider not only the added cost of any device required to carry out the procedure but also many other variables, such as operating room time, length of hospital stay, postoperative wound management, incidence of postoperative complications, time of postoperative recovery, and return to work. For this reason, this kind of calculation can be extremely difficult and complicated. In a recent analysis, Burch et al1 have tried to address this issue using sophisticated economic models and different scenarios. According to their results, conventional hemorrhoidectomy and stapled hemorrhoidpexy had very similar costs and quality-adjusted life-years, the cost of the staple gun being offset by savings in hospital stay. However, the estimates were based on published data and may not necessarily reflect local circumstances. For this reason, we do not think that we have enough evidence at the moment to achieve a definitive conclusion on the financial impact of stapled hemorrhoidpexy on hospitals and society. Whether or not the use of stapled hemorrhoidpexy is a viable option needs to be agreed upon locally based on local needs and circumstances, bearing in mind the available evidence.