Review for 10.1186/s12876-021-01969-1 (2021)

Reviewer’s report
Title: 
Surgical Outcomes of LigaSure Hemorrhoidectomy in the Elderly
Population: A retrospective cohort study
Version: 
0 
Date: 
23 Mar 2021
Reviewer's report:
Thank you for the opportunity to review this retrospective study entitled
"Surgical Outcomes of LigaSure Hemorrhoidectomy in the Elderly Population:A
retrospective cohort study".
This is an original study evaluating the outcome of hemorrhoidectomy with
Ligasure in the elderly population.
I read this article few times and i have some remarks which could hopefully
improve the proposed article.
ABSTRACT
In the background please underline the originality of the study 
In the results just present result without mentioning in the abstract your
interpretation ("The higher incidence of postoperative urinary retention in older
patients is due to the fact that the incidence of benign prostate hypertrophy
occurs more frequently in older patients, rather than being more painful")
INTRODUCTION
1.First 
paragraph: please remove the sentence "However i have some remarks
which could hopefully improve the proposed". I suggest to change the word
"annoying " referred to HD.
2. I suggest to be focus on the aim of your study and to make the introduction
shorter. There is 
no need to 
discuss about the pathophysiology of HD. Authors
do not need to explain the common practice in their surgical unit in the
introduction.
3." In Taiwan, the peopleare generally considered the old population when they
are at the age more than 65 years old. Also, the majority of people will get
retirement
when they are 65 years old.". Please add a reference for this sentence
4. I think that the aim of the study i salso to compare outcomes between two
popultions
METHODS
5. 1075 patients are compared with 163 patients. Could authors motivate the
choice of this statistical analysis instead of a propensity score analysis? 
6. Change diclofenic with diclofenac
7. Authors declare to present data in median. However age is reported as mean
with no SD.
RESULTS
8."those patients with complications were male (p=0.039)"- I suggest to revise
this sentence. Mabe authors should explain that mostly male pts has complication
(compared to women?)
9. Authors do not need to repeat results in the discussion (from "In this study
to….. (0.5% vs. 0.6%, p=0.572)in both groups had no significantly statistical
difference.)
DISCUSSION
10.Please could you simplify the sentence "With regard to hemorrhoidectomy
performed in older patients, what surgeons and patients were most concerned
about was whether older patients had higher complications or surgical risk"?
11. Please in this session discuss the results and not report again results
presented in tables (e.g. Table 3) or p value.
12. Please add the following references to the discussion:
a) Consensus statement of the Italian society of colorectal surgery (SICCR):
management and treatment of hemorrhoidal disease. G Gallo 
DOI:
10.1007/s10151-020-02149-1
b) Surgical management of haemorrhoids: an Italian survey of over 32 000
patients over 17 years. D F Altomare 
DOI: 10.1111/codi.14339
c) 
Excisional Haemorrhoidectomy: 
Where Are We? Sena G
DOI:10.2174/1574887115666200319153439
Minor comment: English should be revised and several sentences have to be
simplified.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
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