Title: Comparison of Efficacy and Safety Between Surgical and Conservative Treatments for
Hemorrhoids: A Meta-Analysis
Version: 0 Date: 13 Apr 2025
Reviewer's report:
This is a systematic review and meta-analysis of surgical and conservative treatments
of haemorrhoids. Authors seem to be proving the effectiveness of surgical treatment for
haemorrhoids. I have some comments and suggestions.
1. There seem to be a contradiction in the results and conclusion section in the abstract. Please
consider revising the results with reference to the conclusion. Short term pain reduction in the
results section and higher risk of post operative pain in the conclusion section. The results section
in the manuscript needs re-writing to clarify the same as in clinical practice postoperative pain is
one of the major issues of haemorrhoidectomy in the short term. Postoperative pain needs more
clarification in the discussion section too.
2. Postoperative urinary retention is a rare complication after surgery. How was this end point
compared with conservative treatment?
3. I suggest including only the 6 RCTs and excluding the cohort study. This will increase the
credibility of this analysis.
4. Furthermore, use Cochrane’s Risk of Bias 2 tool for quality assessment of the RCTs.
5. I2 is not a measure of heterogeneity and may not be quoted in the manuscript. It is Cochrane’s
Q test that determines the heterogeneity along with Tau and Tau squared values.
6. In the results section, authors mention about the discharge comparison between surgical and
conservative treatments. Conservative treatment does not need admission and is carried out as
outpatient. Were patients admitted for conservative treatment? If not this analysis is probably
un necessary.
7. How was the time to recovery measured in the included studies?
8. There is a difference between the actual recurrence and risk of recurrence. How was the risk of
recurrence evaluated? I understand that actual recurrence can be assessed after a certain period
of follow up. What was the follow up in the included studies?
9. Some of the studies included in the analysis reported on the surgical intervention on
thrombosed external haemorrhoids. Did this analysis address emergency or elective treatment
of haemorrhoids?
10. The conclusions drawn from analysis of less than three studies cannot be considered
significant recommendations and may be given in the discussion section. The forest plots of
these results may be excluded.
Title: Comparison of Efficacy and Safety Between Surgical and Conservative Treatments for
Hemorrhoids: A Meta-Analysis
Version: 0 Date: 13 Apr 2025
Reviewer's report:
This is a systematic review and meta-analysis of surgical and conservative treatments
of haemorrhoids. Authors seem to be proving the effectiveness of surgical treatment for
haemorrhoids. I have some comments and suggestions.
1. There seem to be a contradiction in the results and conclusion section in the abstract. Please
consider revising the results with reference to the conclusion. Short term pain reduction in the
results section and higher risk of post operative pain in the conclusion section. The results section
in the manuscript needs re-writing to clarify the same as in clinical practice postoperative pain is
one of the major issues of haemorrhoidectomy in the short term. Postoperative pain needs more
clarification in the discussion section too.
2. Postoperative urinary retention is a rare complication after surgery. How was this end point
compared with conservative treatment?
3. I suggest including only the 6 RCTs and excluding the cohort study. This will increase the
credibility of this analysis.
4. Furthermore, use Cochrane’s Risk of Bias 2 tool for quality assessment of the RCTs.
5. I2 is not a measure of heterogeneity and may not be quoted in the manuscript. It is Cochrane’s
Q test that determines the heterogeneity along with Tau and Tau squared values.
6. In the results section, authors mention about the discharge comparison between surgical and
conservative treatments. Conservative treatment does not need admission and is carried out as
outpatient. Were patients admitted for conservative treatment? If not this analysis is probably
un necessary.
7. How was the time to recovery measured in the included studies?
8. There is a difference between the actual recurrence and risk of recurrence. How was the risk of
recurrence evaluated? I understand that actual recurrence can be assessed after a certain period
of follow up. What was the follow up in the included studies?
9. Some of the studies included in the analysis reported on the surgical intervention on
thrombosed external haemorrhoids. Did this analysis address emergency or elective treatment
of haemorrhoids?
10. The conclusions drawn from analysis of less than three studies cannot be considered
significant recommendations and may be given in the discussion section. The forest plots of
these results may be excluded.
Please review this paper.
user
Title: Comparison of Efficacy and Safety Between Surgical and Conservative Treatments for
Hemorrhoids: A Meta-Analysis
Version: 0 Date: 13 Apr 2025
Reviewer's report:
This is a systematic review and meta-analysis of surgical and conservative treatments
of haemorrhoids. Authors seem to be proving the effectiveness of surgical treatment for
haemorrhoids. I have some comments and suggestions.
1. There seem to be a contradiction in the results and conclusion section in the abstract. Please
consider revising the results with reference to the conclusion. Short term pain reduction in the
results section and higher risk of post operative pain in the conclusion section. The results section
in the manuscript needs re-writing to clarify the same as in clinical practice postoperative pain is
one of the major issues of haemorrhoidectomy in the short term. Postoperative pain needs more
clarification in the discussion section too.
2. Postoperative urinary retention is a rare complication after surgery. How was this end point
compared with conservative treatment?
3. I suggest including only the 6 RCTs and excluding the cohort study. This will increase the
credibility of this analysis.
4. Furthermore, use Cochrane’s Risk of Bias 2 tool for quality assessment of the RCTs.
5. I2 is not a measure of heterogeneity and may not be quoted in the manuscript. It is Cochrane’s
Q test that determines the heterogeneity along with Tau and Tau squared values.
6. In the results section, authors mention about the discharge comparison between surgical and
conservative treatments. Conservative treatment does not need admission and is carried out as
outpatient. Were patients admitted for conservative treatment? If not this analysis is probably
un necessary.
7. How was the time to recovery measured in the included studies?
8. There is a difference between the actual recurrence and risk of recurrence. How was the risk of
recurrence evaluated? I understand that actual recurrence can be assessed after a certain period
of follow up. What was the follow up in the included studies?
9. Some of the studies included in the analysis reported on the surgical intervention on
thrombosed external haemorrhoids. Did this analysis address emergency or elective treatment
of haemorrhoids?
10. The conclusions drawn from analysis of less than three studies cannot be considered
significant recommendations and may be given in the discussion section. The forest plots of
these results may be excluded.
assistant