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: 
1 
Date: 
28 Jul 2021
Reviewer: 
Iacopo Giani
Reviewer's report:
I want to congratulate the authors for their paper. I think it deserves to be
published in the face of small variations: 
Chapter 2.5. The primary and secondary outcomes: The primary outcome is
focused on whether old age is a complication factor after hemorrhoidectomy.
The secondary outcome is to examine risk factors of complications after
hemorrhoidectomy.
It is not clear which is the Primary Outcome, you can not say what reported
above, you shoud say for example "complication rate" or "bleeding" of "prolapse
recurrence"...
There is also an important BIAS unfortunately common to many papers on
hemorrhoid surgery, namely the failure to refer to the number of hemorrhoids
performed on each patient. It would be useful to indicate that all patients have
always undergone 3 haemorrhoidectomies each (if it is true) because in the event
that some patients turn out to have been treated with a different number of
haemorrhoidectomies, an extreme difference in the results would emerge.
I suggest first of all to see if the two groups are homogeneous also on the basis of
the number of haemorrhoidectomies for each patient, finally highlight if there are
differences in the result based on the number of wounds - haemorrhoidectomies
performed.
I suggest you to read and cite this paper:
Updates Surg. 2014 Dec;66(4):283-7. Tailored excisional treatment for high-
grade haemorrhoidal disease.
Best regards.
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