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: 
30 Mar 2021
Reviewer's report:
Thank you for an opportunity to review an original article entitled "Surgical
Outcomes of LigaSure Hemorrhoidectomy in the Elderly Population: A
retrospective cohort study"- in which the authors concluded that this study
indicated that hemorrhoidectomy performed in selective elder population is safe
and effective. There are no significant differences between the elder population
and younger patients for short-term surgical outcomes and total complications.
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. Obviously, the latter sentence
has no scientific support from this study.
Other concerns of mine included:
1. There is no definition of outcomes measured especially for the primary
outcomes (complication and delayed bleeding).
2. the authors stated that all patients received oral diclofenic (75 mg) twice daily.
I wondered whether some elderly had contraindication for this drug e.g. kidney
or UGI diseases. 
3. Also the author stated that if patients could not tolerate the pain, morphine
(5mg) was given intravenously as needed every 6 hours. Again, no defined pain
score for having rescue morphine and morphine 5 mg may be too much for
elderly ! 
4. Pain scores were reported but we did not know how and when they were
recorded.
5. The authors mentioned frequency of ketoprofen or morphine injection
postoperatively (FKMIP) in the results, but no ketoprofen was ever noted in the
methodology.
6. It would be better to included factors with p-value <0.2 (rather than <0.1 in the
present study) in univariable logistic regression models in the multivariable
logistic regression model.
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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?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes