Review for 10.1186/s12876-023-02933-x (2023)

Title: Milligan-Morgan hemorrhoidectomy combined with non-Doppler hemorrhoidal artery
ligation for the treatment of grade III/IV hemorrhoids: A single centre retrospective study
Version: 2 Date: 29 Jun 2023
Reviewer's report:
Comments to the Authors
This is a valuable study comparing standard haemorrhoidectomy (MMH) with combined MMH
and HAL procedure. Furthermore, the results are surprisingly clear and significant. I should be
grateful if you could answer my comments shown below.
Major comments
Unfortunately, the number of pages and lines are not given, which made my peer review difficult.
Minor comments
Abstract
---In Background, “Milligan-Morgan hemorrhoidectomy combined with non-Doppler
hemorrhoidal artery ligation (MMH+ND-HAL)” should be “MMH combined with non-Doppler
hemorrhoidal artery ligation (MMH+ND-HAL)".
---In Results, “satisfaction was higher than in the MMH group than in the MMH+ND-HAL
group (P < 0.05)” should be “satisfaction was higher in the MMH+ND-HAL group than in the
MMH group (P < 0.05)".
Background
---The sentence “Hemorrhoidectomy is the first choice for grade III/IV hemorrhoids patients”
should be “Hemorrhoidectomy is the first choice for patients with grade III/IV hemorrhoids”
---The sentence “Milligan-Morgan hemorrhoidectomy (MMH) was one of the most widely used
and representative operations” should be “Milligan-Morgan hemorrhoidectomy (MMH) is one
of the most widely used and representative operations”.
---The sentence “we adopted MMH+ND-HAL, a new combined operation, to overcome some
limitations of MMH” should be “we adopted MMH combined with non-Doppler hemorrhoidal
artery ligation (MMH+ND-HAL)” since the “ND-HAL” is first appearance in the main text.
Materials and methods
---In Data Collection, it is unclear how to determine the recurrence and patient satisfaction. Did
you define any prolapse, including grade 2 hemorrhoids, as a recurrence? Regarding patient
satisfaction, for example, did you define "satisfaction" as the sum of "somewhat satisfied" and
"very satisfied"?
---In Surgical Procedures, the sentence “the index finger was used to find the fluctuating
hemorrhoid artery” should be “the index finger was used to find the pulsating hemorrhoidal
artery”.
---In Surgical Procedures, the sentence “the fluctuating hemorrhoid arteries were ligated with
2-0 absorbable suture” should be “the pulsating hemorrhoidal arteries were ligated with 2-0
absorbable suture”.
---In Surgical Procedures, the sentence “the ligation position was 3, 7, or 11 points above the
dental line” should be “the ligation position was 3, 7, or 11 o’clock points above the dental line”.
Result
---In Patient Characteristics, there is too much overlap between the text and Table 1. In addition,
the phrase "course of disease" is more easily understood as “duration of disease”. Therefore,
why not modify it as follows?
Suggested text;
We enrolled a total of 53 patients in the MMH+ND-HAL group (among which 45 patients had
grade III hemorrhoids, and 8 patients had grade IV hemorrhoids) and 62 patients in the MMH
group (52 patients had grade III hemorrhoids, 10 patients had grade IV hemorrhoids). There
were no significant differences in age, sex, duration of disease, hemorrhoid grade, or number of
surgical incisions between the two groups, but intraoperative bleeding in the MMH+ND-HAL
group was less than in the MMH group (P < 0.05) (Table 1).
Discussion
---The phrase “Doppler-guided/-assisted hemorrhoid artery ligation (HAL)” should be
“Doppler-guided/-assisted HAL”.
---“PS on the basis of MMH” is not clear, PS should be spelled out as it is the first time it appears.
---The phrase “generally 3, 7, or 11 points” should be “generally 3, 7, or 11 o’clock points”.
---The phrase “anal stasis or anal continuity” may be “anal stenosis or anal incontinence”.
Conclusion
---The sentences “MMH+ND-HAL was a satisfactory surgical modality for treating III/IV
hemorrhoids. This procedure was associated with reduced complications, a low recurrence rate,
and high patient satisfaction” should be “MMH+ND-HAL had fewer complications, lower
recurrence rate, and higher patient satisfaction than MMH alone. Therefore, MMH+ND-HAL
appears to be a satisfactory surgical procedure in the treatment of grade III/IV hemorrhoids”.
References
---The number “1” of Ref. 1 is missing.
Figure Legends
--- The phrase “the fluctuating hemorrhoid artery” should be “the pulsating hemorrhoidal artery”