Review for 10.1186/s12876-025-03848-5 (2025)

Title: Comparing surgical and conservative treatment approaches for perianal abscess in patients
with hematologic malignancies: a comprehensive analysis
Version: 4 Date: 18 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the study provides details on patient selection and the treatment groups, there is no
specific mention of the inclusion and exclusion criteria for selecting patients from the cohort. It
would be helpful to include this information to ensure transparency and reproducibility of the
study.
-Are patients with certain comorbidities excluded? Are there other factors (e.g., severity of the
abscess) that influence the treatment choice between surgery and conservative care?
The "conservative treatment group" is described as receiving only antibiotic therapy. It would
be useful to elaborate on whether this includes any other management steps, such as local care
or drainage attempts, or if antibiotics were the sole intervention.
-Additionally, specifying whether any guidelines or protocols were followed for antibiotic
selection could add depth to the methodology.
-The methods mention the examination of "microbial origins of pus," but there is no further
detail on how this was done (e.g., culture methods, identification of specific bacteria or fungi).
Including a brief description of the microbial testing methods would enhance the methodology’s
clarity and ensure readers understand how these data were collected and interpreted.
-While the methods section outlines various demographic and clinical characteristics as part of
the observation indicators, the specific outcome measures are not detailed. For example, how
were "prognosis" and recovery defined and measured? Were outcomes such as resolution of
the abscess, recurrence, or healing time specifically tracked? Providing more insight into these
outcomes will better frame the analysis and results.
-The discussion notes that conservative treatment showed successful outcomes with minimal
complications, but it also mentions that there was a significant incidence of complications
and even mortality in the conservative treatment group. It might be worth further elaborating
on why conservative treatment led to severe outcomes in some cases, especially since one
patient developed necrotizing fasciitis. More details about the clinical course of the conservative
treatment group and any potential predictors of these severe outcomes would provide a more
balanced view.
-While the study highlights complications and recurrence, it would be helpful to discuss any
potential role of microbial pathogens in recurrence or complications. Were certain types of
bacteria or fungal infections more prevalent in the conservative group? How might this impact
treatment strategies? Providing some insight into this would enhance the discussion.
-The discussion acknowledges the study's retrospective design and small sample size, but it could
benefit from a more detailed analysis of potential confounders. For example, were there any
other variables (e.g., coexisting conditions, chemotherapy regimen) that might have influenced
outcomes? Addressing this in more detail would allow readers to assess the robustness of the
findings and the limitations of the study.
-Additionally, it might be helpful to acknowledge the limitations of the imaging techniques
used (e.g., MR imaging), especially since some studies suggest that perianal abscesses in
immunocompromised patients may not be as clearly identifiable through imaging.