The HubBLe randomized trial compared haemorrhoidal artery ligation with rubber band ligation for symptomatic second- and third-degree haemorrhoids. The study is useful because both techniques are designed to avoid conventional excisional haemorrhoidectomy, yet they differ in invasiveness, recurrence profile, postoperative discomfort and resource requirements. The trial found that both approaches were effective, but they did not offer identical trade-offs. Rubber band ligation remained a simple and relatively inexpensive outpatient option, while haemorrhoidal artery ligation involved a more procedural approach with different patterns of recurrence and postoperative experience. For surgeons, the key lesson is that “less invasive” does not automatically mean “better” across every endpoint. Treatment choice should consider haemorrhoid grade, symptom pattern, patient expectations, recurrence tolerance, availability of anaesthesia and local expertise. The evidence also supports a step-up philosophy in proctology: the simplest effective intervention should often be considered first, with more invasive options reserved for patients who need them. HubBLe is particularly relevant to the ASICON proctology focus because it demonstrates how comparative trials can help surgeons choose between modern minimally invasive treatments rather than relying solely on technical preference or habit.