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.
Publons Reviewer Recognition
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find the details of processing in Publons’ privacy policy
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Yes
Declaration of competing interests
Please complete a declaration of competing
interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
No conflict of interest to declare
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
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?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
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.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
Yes
Declaration of competing interests
Please complete a declaration of competing
interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
No conflict of interest to declare
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
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?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
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.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
Yes
Declaration of competing interests
Please complete a declaration of competing
interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
No conflict of interest to declare
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
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?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant