Review for 10.1186/s12876-021-02079-8 (2022)

Reviewer’s report
Title: 
A Systematic Review of the Patient Burden of Crohn’s Disease-related
Rectovaginal and Anovaginal Fistulas
Version: 
0 
Date: 
21 May 2021
Reviewer: 
Silvio Laureti
Reviewer's report:
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Thanks to the Authors for this is 
well conducted systematic review on Patient
Burden of Crohn's Disease-related Rectovaginal and Anovaginal Fistulas.
This is an important topic, since RVF is particularly devastating and disabling
condition with a significant negative impact on quality of life and is a
notoriously difficult to treat. 
The Authors highlight the presence in the literature 
of many 
impacting bias
related to the lack of uniformly accepted definition of healing, 
standardized
treatments and stratification of clinical features. 
Techniques for repair of
rectovaginal fistulas are numerous, each with varying degrees of invasiveness,
complications, and success: In addition combined tratment with surgical
drainage and biologic therapy represents 
the gold standard for this features.
Rescue therapy with surgical local repair or subsequent graciloplasty is the final
step of the algorithm. 
The Authors did not analyzed the results of each step and do not provide a guide
to make up for the bias found in the studies considered in the review. 
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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
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